SUSAN PETOKAS CRNP NPI 1467767590

NPI Information

  • NPI: 1467767590
  • Provider Name: SUSAN PETOKAS, CRNP
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 820 S WASHINGTON AVE
    SCRANTON, PA
    ZIP 18505
  • Phone: (570) 595-4496

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NPI Details

Susan Petokas, CRNP is a nurse practitioner in Scranton, PA. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Susan Petokas, CRNP NPI is 1467767590. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

820 S WASHINGTON AVE
SCRANTON, PA
ZIP 18505-639
Phone: (570) 595-4496
Fax: (570) 961-3844

The NPI 1467767590 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/12/2010 and was last updated on 8/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilySP001243BPENNSYLVANIANo
2363L00000XNurse PractitionerSP001243BPENNSYLVANIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11007678420050MEDICAIDPENNSYLVANIA
21026041580002MEDICAIDPENNSYLVANIA
31007678420035MEDICAIDPENNSYLVANIA
4102604158004MEDICAIDPENNSYLVANIA
5102604158005MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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