Basic Information
| Provider Information | |||||||||
| NPI: | 1841453511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENGLES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | CRNP,APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 N MAIN ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095368272 | ||||||||
| FaxNumber: | 6095368273 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 N MAIN ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095368272 | ||||||||
| FaxNumber: | 6095368273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2008 | ||||||||
| LastUpdateDate: | 09/06/2016 | ||||||||
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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 | 363LA2200X | SP009651 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0515884 | 05 | NJ | MEDICAID | 1027861860001 | 05 | PA | MEDICAID |