Organization
SUSQUEHANNA PHYSICIAN SERVICES
Active
Other names
SPS-BHL/CRNP
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES SANTANGELO (EXECUTIVE VP/CFO)
(570) 321-3171
Entity
Organization
Contact information
Practice address
145 SHAFFER ST, SOUTH WILLIAMSPORT, PA 17702-6799
(570) 326-2447
(570) 326-1247
Mailing address
1201 GRAMPIAN BLVD, PO BOX 3127, WILLIAMSPORT, PA 17701-0127
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017300760169
—
PA
Enumeration date
05/18/2009
Last updated
06/09/2009
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