Provider Demographics
NPI:1447300777
Name:VANCLEVE, SUSAN NICKEL (CRNP, CPNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NICKEL
Last Name:VANCLEVE
Suffix:
Gender:F
Credentials:CRNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 HARROGATE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2030
Mailing Address - Country:US
Mailing Address - Phone:412-854-4767
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL OF PITTSBURGH
Practice Address - Street 2:3705 FIFTH AVENUE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-692-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000425D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics