Provider Demographics
NPI:1194296129
Name:DOCK, SUSAN E (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DOCK
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 1:155 REDCORT LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-9101
Mailing Address - Country:US
Mailing Address - Phone:570-809-2106
Mailing Address - Fax:
Practice Address - Street 1:412 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-1076
Practice Address - Country:US
Practice Address - Phone:570-837-6163
Practice Address - Fax:570-837-7224
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019668207Q00000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care