1. Home
  2. Directory
  3. Pennsylvania
  4. Brookhaven
  5. Nurse Practitioner
  6. NPI Profile

MARY SUE NICHOLSON CRNP
NPI 1063662849
Nurse Practitioner - Family in Brookhaven, PA

Active since September 29, 2008
4098 EDGMONT AVE, BROOKHAVEN, PA 19015(866) 825-3227(484) 450-2617 Get Directions Write a Review

NPPES record last updated: September 29, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mary Sue Nicholson Crnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY SUE NICHOLSON CRNP (NPI 1063662849) is an individual family provider in Brookhaven, Pennsylvania, licensed in Pennsylvania (SP007470) and active in the NPI registry since September 2008.

NPPES Registry Identity

NPI1063662849
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameMARY SUE NICHOLSONCredential: CRNP
Location Address4098 EDGMONT AVEBrookhaven, PA 19015-2211
Mailing Address161 Washington St, Eight Tower Bridge Ste 1400Conshohocken, PA 19428-2083 · (866) 825-3227 · Fax (484) 450-2617
Phone(866) 825-3227
Fax(484) 450-2617
Sole ProprietorNo
Enumeration DateSeptember 29, 2008
✔ NPI 1063662849 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in PA · SP007470
4098 EDGMONT AVE, Brookhaven, PA 19015
Open in Google Maps ↗

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

XIEM NGUYEN-YIP
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
MS. KIMBERLY NICOLE KLEEMAN PHARMD
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
MAKSIM DAKU
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
DARIA ANNETTE TATOM
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
WALGREEN EASTERN CO INC
Pharmacy
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
KENNY KHOI AO
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
MR. BRIAN J GRACI RPH
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815
RICHARD DONG
Pharmacist
4098 EDGMONT AVE
BROOKHAVEN, PA 19015
Delaware County (610) 876-8815

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Nicholson's NPI number?

The NPI number for Mary Nicholson is 1063662849. It was assigned to this individual provider in the NPPES registry on September 29, 2008.

Where is Mary Nicholson located?

Mary Nicholson practices at 4098 Edgmont Ave, Brookhaven, PA 19015. The listed phone number is (866) 825-3227.

What is Mary Nicholson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Mary Nicholson was last updated on September 29, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.