Provider Demographics
NPI:1962517342
Name:HARKINS, SUSAN JEAN (GNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:HARKINS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JEAN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:99 SIXTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357
Mailing Address - Country:US
Mailing Address - Phone:315-895-4050
Mailing Address - Fax:315-895-7197
Practice Address - Street 1:99 SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357
Practice Address - Country:US
Practice Address - Phone:315-895-4050
Practice Address - Fax:315-895-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340357363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS46051Medicare UPIN
NY002973Medicare ID - Type Unspecified