Individual
SUZANNE MARIE OBENRADER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP RN
Contact information
Practice address
515 PENNSYLVANIA AVE, 2ND FL SUITE A, FORT WASHINGTON, PA 19034-3314
(215) 540-8404
(215) 540-8418
Mailing address
PO BOX 820933, PHILADELPHIA, PA 19182-0933
(215) 540-8408
(215) 540-8418
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN18636FL
PA
363L00000X
Nurse Practitioner
Primary
UP000800H
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30019410
KMHP
PA
01
—
574399
COVENTRY HEALTH AMERICA
PA
Enumeration date
12/06/2005
Last updated
11/08/2013
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