Provider Demographics
NPI:1861098485
Name:WARD, SUZANNE M (CRNP PMHNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:WARD
Suffix:
Gender:F
Credentials:CRNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-8261
Mailing Address - Country:US
Mailing Address - Phone:717-994-5612
Mailing Address - Fax:
Practice Address - Street 1:134 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-2129
Practice Address - Country:US
Practice Address - Phone:717-437-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN631819163W00000X
PASP023279363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038786670001Medicaid