Provider Demographics
NPI:1902124563
Name:WILLER, SUSAN JOYCE (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JOYCE
Last Name:WILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1320
Mailing Address - Country:US
Mailing Address - Phone:585-264-9024
Mailing Address - Fax:
Practice Address - Street 1:794 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1320
Practice Address - Country:US
Practice Address - Phone:585-264-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290856-1163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care