Provider Demographics
NPI:1487694774
Name:MIDILI, SUSAN M (APN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MIDILI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7665 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3328
Mailing Address - Country:US
Mailing Address - Phone:856-665-9520
Mailing Address - Fax:856-665-6684
Practice Address - Street 1:7665 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3328
Practice Address - Country:US
Practice Address - Phone:856-665-9520
Practice Address - Fax:856-665-6684
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN104570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ42929Medicare UPIN
NJ090360Medicare ID - Type Unspecified