Provider Demographics
NPI:1396914354
Name:MONTAG, SUSAN E (DNP, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:MONTAG
Suffix:
Gender:F
Credentials:DNP, CRNP, FNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:CHAFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 HILLCREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-7066
Mailing Address - Fax:814-938-4509
Practice Address - Street 1:81 HILLCREST DR STE 100
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-7066
Practice Address - Fax:814-938-4509
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103136604-0003Medicaid