Provider Demographics
NPI:1316609134
Name:MACAVOY, SUSANNE CHRISTINE (CRNP)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:CHRISTINE
Last Name:MACAVOY
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 1:184 WINDERMERE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1540
Mailing Address - Country:US
Mailing Address - Phone:484-716-7843
Mailing Address - Fax:
Practice Address - Street 1:965 BALTIMORE PIKE STE B2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3997
Practice Address - Country:US
Practice Address - Phone:484-573-5116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner