Provider Demographics
NPI:1164268280
Name:VAN GELDER, SUSAN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:VAN GELDER
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 1:8272 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840
Mailing Address - Country:US
Mailing Address - Phone:607-569-5200
Mailing Address - Fax:607-569-5212
Practice Address - Street 1:8272 MAIN ST HAMMONDSPORT CSD
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840
Practice Address - Country:US
Practice Address - Phone:607-569-5200
Practice Address - Fax:607-569-5212
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse