MRS. SUSAN WARD, NP-C - NPI NUMBER 1023303260

Summary

Provider Name: MRS. SUSAN WARD, NP-C

NPI Number: 1023303260

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Address:
1906 AUTUMN GLEN CIR
VICTOR, ID
ZIP 83455

Phone Number: (208) 201-4774



Detailed Information

MRS. Susan Ward, NP-C is a family nurse practitioner in Victor, ID. The assigned NPI number for this provider is 1023303260 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

1906 AUTUMN GLEN CIR
VICTOR, ID
ZIP 83455-629
Phone: (208) 201-4774

The enumeration date for this NPI number is 6/16/2011 and was last updated on 6/24/2011.

Map - Location of Practice





Taxonomy Codes

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 363LF0000X Nurse Practitioner Family 20778.1114 WY No
2 363LF0000X Nurse Practitioner Family NP-1071A ID Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1023303260 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name WARD The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name SUSAN The first name of the provider, if the provider is an individual.
5 Provider Name Prefix Text MRS. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
6 Provider Credential Text NP-C The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
7 Provider First Line Business Practice Location Address 1906 AUTUMN GLEN CIR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Business Practice Location Address City Name VICTOR The city name in the location address of the provider being identified.
9 Provider Business Practice Location Address State Name ID The State code in the location of the provider being identified.
10 Provider Business Practice Location Address Postal Code 834554629 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
11 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
12 Provider Business Practice Location Address Telephone Number 2082014774 The telephone number associated with the location address of the provider being identified.
13 Provider Enumeration Date 6/16/2011 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 6/24/2011 The date that a record was last updated or changed.
15 Provider Gender Code F The code designating the provider’s gender if the provider is a person.
16 Healthcare Provider Taxonomy Code 1 363LF0000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
17 Provider License Number 1 20778.1114 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
18 Provider License Number State Code 1 WY The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
19 Healthcare Provider Primary Taxonomy Switch 1 N
20 Healthcare Provider Taxonomy Code 2 363LF0000X
21 Provider License Number 2 NP-1071A The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 2 ID The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 2 Y
24 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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