Provider Demographics
NPI:1932745759
Name:FEDERICO, SUSAN M (WHNP BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FEDERICO
Suffix:
Gender:F
Credentials:WHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416B N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1740
Mailing Address - Country:US
Mailing Address - Phone:609-402-4900
Mailing Address - Fax:609-402-4944
Practice Address - Street 1:416B N 3RD ST
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1740
Practice Address - Country:US
Practice Address - Phone:609-402-4900
Practice Address - Fax:609-402-4944
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00986200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner