Individual provider Active NPI

Suzanne Willard, CRNP

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1295779742
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
VP001737C Issued in PA
Practice address
1427 Vine St
3Rd FLR
Philadelphia, PA 19102-1031
Phone
(215) 762-2530
Fax
(215) 762-2531
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X VP001737C PA Primary

Addresses

Primary practice location

1427 Vine St
3Rd FLR
Philadelphia, PA 19102-1031

Mailing address

6123 Wayne Ave
Philadelphia, PA 19144-6103
Phone (215) 768-0337

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers Focus Wellness Center Past Accepting new patients
Rutgers Nursing Faculty Practice Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1295779742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 WAYNE AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191446103",
            "telephone_number": "215-768-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 VINE ST",
            "address_2": "3RD FLR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021031",
            "telephone_number": "215-762-2530",
            "fax_number": "215-762-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLARD",
        "first_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "VP001737C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.