Individual
SUSAN NIFENECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
2146 JACKSON AVE, SEAFORD, NY 11783-2606
(516) 221-3030
(516) 221-1013
Mailing address
2146 JACKSON AVE, SEAFORD, NY 11783-2606
(516) 221-3030
(516) 221-1013
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
F400714-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003933339
—
NY
Enumeration date
08/15/2006
Last updated
08/03/2015
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