Provider Demographics
NPI:1740987783
Name:FENTON, SUSANNA CLARE (NPWH)
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:CLARE
Last Name:FENTON
Suffix:
Gender:F
Credentials:NPWH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HUGUENOT ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1018
Mailing Address - Country:US
Mailing Address - Phone:845-399-0245
Mailing Address - Fax:
Practice Address - Street 1:21 GRAND ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3933
Practice Address - Country:US
Practice Address - Phone:845-562-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421630-01363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health