Mary Sue Nicholson, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP007470 Issued in PA

Practice address

4098 Edgmont Ave
Brookhaven, PA 19015-2211

Phone

(866) 825-3227

Fax

(484) 450-2617

NPI assigned

Sep 29, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222646400000",
    "number": "1063662849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "161 WASHINGTON ST",
            "address_2": "EIGHT TOWER BRIDGE STE 1400",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282083",
            "telephone_number": "866-825-3227",
            "fax_number": "484-450-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4098 EDGMONT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152211",
            "telephone_number": "866-825-3227",
            "fax_number": "484-450-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "MARY",
        "middle_name": "SUE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-29",
        "last_updated": "2008-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP007470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Brookhaven, PA
• Providers in Brookhaven, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.