Provider Demographics
NPI:1245499268
Name:BERGDOLL-FAYKES, SUSAN AMY (MSN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:AMY
Last Name:BERGDOLL-FAYKES
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2816
Mailing Address - Country:US
Mailing Address - Phone:609-261-4058
Mailing Address - Fax:609-261-8381
Practice Address - Street 1:693 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08048-5043
Practice Address - Country:US
Practice Address - Phone:609-261-4058
Practice Address - Fax:609-261-8381
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN06050200163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics