Provider Demographics
NPI:1972519619
Name:MCGINLEY, SUSAN RUETER (CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUETER
Last Name:MCGINLEY
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 1:1800 LOMBARD ST
Mailing Address - Street 2:STE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1414
Mailing Address - Country:US
Mailing Address - Phone:215-615-2222
Mailing Address - Fax:215-893-7317
Practice Address - Street 1:1800 LOMBARD ST
Practice Address - Street 2:STE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1414
Practice Address - Country:US
Practice Address - Phone:215-615-2222
Practice Address - Fax:215-893-7317
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007257363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health