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Individual
SUSAN PETOKAS
Active
Individual
SUSAN PETOKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP001243B
PA
363LF0000X
Family Nurse Practitioner
SP001243B
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007678420035
—
PA
05
—
1007678420050
—
PA
05
—
1026041580002
—
PA
05
—
102604158004
—
PA
05
—
102604158005
—
PA
Enumeration date
08/12/2010
Last updated
08/16/2024
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