Basic Information
Provider Information
NPI: 1699753699
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARE
FirstName: SUSAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3 HOSPITAL DR
Address2: SUITE 312
City: LEWISBURG
State: PA
PostalCode: 178379362
CountryCode: US
TelephoneNumber: 5705238700
FaxNumber: 5705238705
Practice Location
Address1: 3 HOSPITAL DR
Address2: SUITE 312
City: LEWISBURG
State: PA
PostalCode: 178379362
CountryCode: US
TelephoneNumber: 5705238700
FaxNumber: 5705238705
Other Information
ProviderEnumerationDate: 01/09/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
176B00000XMW 010074PAY Other Service ProvidersMidwife 

No ID Information.


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