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Individual
MS. SUE PETERSEN MCKINNEY
Active
Individual
MS. SUE PETERSEN MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002820
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000412001001
BSNENY
NY
05
—
02820226
—
NY
01
—
070507000061
FIDELIS
NY
01
—
710843
MVP
NY
Enumeration date
08/20/2006
Last updated
01/26/2018
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