Basic Information
| Provider Information | |||||||||
| NPI: | 1568573244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINCHESTER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RN,MS,FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 989 ROUTE 146 | ||||||||
| Address2: | BUILDING 200 | ||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120653646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183830891 | ||||||||
| FaxNumber: | 5183831662 | ||||||||
| Practice Location | |||||||||
| Address1: | 989 ROUTE 146 | ||||||||
| Address2: | BUILDING 200 | ||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120653646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183830891 | ||||||||
| FaxNumber: | 5183831662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F334745 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 102388 | 01 | NY | GHI/HMO | OTHER | 02713959 | 05 | NY | MEDICAID | 385801 | 01 | NY | MVP HEALTHCARE | OTHER | 000410779001 | 01 | NY | BSNENY | OTHER | 070327000106 | 01 | NY | FIDELIS | OTHER | 200439 | 01 | NY | SENIOR WHOLE HEALTH | OTHER |