SUSAN K. PETERSON PA NPI 1205946613

NPI Information

NPI: 1205946613
Provider Name: SUSAN K. PETERSON, PA
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Address:
11143 PARKVIEW PLAZA DR
100
FORT WAYNE, IN
ZIP 46845
Phone: (260) 484-8830
Get Directions

Susan K. Peterson, PA is a medical physician assistant in Fort Wayne, IN. Susan K. Peterson, PA NPI is 1205946613. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

11143 PARKVIEW PLAZA DR
100
FORT WAYNE, IN
ZIP 46845-727
Phone: (260) 484-8830
Fax: (260) 483-1911

The enumeration date for this NPI number is 8/30/2006 and was last updated on 10/29/2009.

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
1	363AM0700X	Physician Assistant	Medical	10000342A	INDIANA	Yes

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
1	000000528371	OTHER	INDIANA	ANTHEM PIN
2	055770M	MEDICARE PIN	INDIANA

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: 4/28/2024

NPI Synchronization or Removal

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