Provider Demographics
NPI:1700095395
Name:POWERS, SUSAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:CROTON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:10519-0011
Mailing Address - Country:US
Mailing Address - Phone:845-628-5149
Mailing Address - Fax:845-628-0031
Practice Address - Street 1:6 RIDGE LN
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1402
Practice Address - Country:US
Practice Address - Phone:845-661-9259
Practice Address - Fax:845-628-0031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237734164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02428619Medicaid