Provider Demographics
NPI:1306907241
Name:MCGETTIGAN, SUZANNE (CRNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MCGETTIGAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:BENSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:15 PENN TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-3958
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:16 PENN TOWER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-6397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008247363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ42455Medicare UPIN
PA090500Medicare ID - Type Unspecified