Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN332858L | PA |
NPI | 1003894114 |
---|---|
Provider Name | Ms. Susan U Haikes |
First Address | Scranton, PA 18508-2572 |
Second Address | Dickson City, PA 18519-1668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 10/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S62301 | (02) |