Provider Demographics
NPI:1699147512
Name:O'LEARY, SUZANNE T (CRNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:T
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:T
Other - Last Name:BERGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1088 W BALTIMORE PIKE STE 2202
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5136
Mailing Address - Country:US
Mailing Address - Phone:484-442-8235
Mailing Address - Fax:484-443-8039
Practice Address - Street 1:825 OLD LANCASTER RD STE 420
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3236
Practice Address - Country:US
Practice Address - Phone:610-527-4896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMLHC TIN