Provider Demographics
NPI:1487763298
Name:LINDBERG, SUSAN BENSON (FNP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BENSON
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 MARION ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2113
Mailing Address - Country:US
Mailing Address - Phone:315-866-6817
Mailing Address - Fax:
Practice Address - Street 1:3085 BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NY
Practice Address - Zip Code:13416
Practice Address - Country:US
Practice Address - Phone:315-845-6100
Practice Address - Fax:315-845-6035
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS98002Medicare UPIN