1144582990 NPI number — MS. SUSAN K KEIM MSN, MS, CRNP

Table of content: MS. SUSAN K KEIM MSN, MS, CRNP (NPI 1144582990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144582990 NPI number — MS. SUSAN K KEIM MSN, MS, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEIM
Provider First Name:
SUSAN
Provider Middle Name:
K
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, MS, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNAPP
Provider Other First Name:
SUSAN
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144582990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 MAPLE LEAF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08057-1841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-235-5685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 SPRING GARDEN ST
Provider Second Line Business Practice Location Address:
3RD FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-988-9555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  SP011890 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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