Provider Demographics
NPI:1750878567
Name:GARCIA, SUSANA ENRIQUETA (CRNP)
Entity type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:ENRIQUETA
Last Name:GARCIA
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 1:1565 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-4744
Mailing Address - Country:US
Mailing Address - Phone:610-867-5365
Mailing Address - Fax:610-867-5366
Practice Address - Street 1:1565 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4744
Practice Address - Country:US
Practice Address - Phone:610-867-5365
Practice Address - Fax:610-867-5366
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018752363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty