Provider Demographics
NPI:1720161490
Name:SAILER, SUSAN M (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:SAILER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:361 MEDICAL OFFICE BUILDING,EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-6420
Mailing Address - Fax:610-649-4689
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:361 MEDICAL OFFICE BUILDING, EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-6420
Practice Address - Fax:610-649-4689
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005729B363L00000X, 363LF0000X
PARN271591L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS90681Medicare UPIN