Provider Demographics
NPI:1316325400
Name:MEDINA, SUZANNE (CRNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MAKOUL-MEDINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-4734
Practice Address - Fax:717-782-4727
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014865363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner