Provider Demographics
NPI:1063406122
Name:DRIES, SUSAN E (LPN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:DRIES
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:867 BERKSHIRE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1280
Mailing Address - Country:US
Mailing Address - Phone:610-685-9600
Mailing Address - Fax:610-685-6700
Practice Address - Street 1:867 BERKSHIRE BLVD
Practice Address - Street 2:STE 100
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1280
Practice Address - Country:US
Practice Address - Phone:610-685-9600
Practice Address - Fax:610-685-6700
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN051793L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse