Provider Demographics
NPI:1649330135
Name:BECKER, SUSAN ANN (APN C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:APN C
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ANN
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 95000 LB# 7550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:90 KYMER RD
Practice Address - Street 2:
Practice Address - City:BRANCHVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07826
Practice Address - Country:US
Practice Address - Phone:973-386-3181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N011489900163W00000X
NJ26NJ00092700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00213700OtherCDS
NJMD1424035OtherDEA