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Individual

SUSAN PETOKAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
820 S WASHINGTON AVE, SCRANTON, PA 18505-1639
(570) 595-4496
(570) 961-3844
Mailing address
15 PUBLIC SQ STE 600, WILKES BARRE, PA 18701-1704
(570) 826-1777
(570) 823-3450

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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