Provider Demographics
NPI:1528071552
Name:HOLTON, SUSAN J (CRNP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:J
Last Name:HOLTON
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 1:32 W EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3315
Mailing Address - Country:US
Mailing Address - Phone:215-248-0243
Mailing Address - Fax:
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-823-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN303136L163W00000X, 163WC2100X, 163WE0900X, 163WR0400X, 163WW0000X
PATP003487H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal Therapy
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology