Provider Demographics
NPI:1679732820
Name:PANNABECKER, SUZANNE (CRNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:PANNABECKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S 6TH AVE
Mailing Address - Street 2:PO BOX 16052
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1426
Mailing Address - Country:US
Mailing Address - Phone:610-988-9438
Mailing Address - Fax:
Practice Address - Street 1:300 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1426
Practice Address - Country:US
Practice Address - Phone:610-988-9438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP005570G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAUP005570GOtherSTATE LICENSE