1023303260 NPI NUMBER - MRS. SUSAN WARD, NP-C
Summary
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NPI Number |
1023303260 |
| Entity Type Code |
Individual |
| Provider Legal Name |
MRS. SUSAN WARD, NP-C |
| Provider Business Practice Location Address |
1906 AUTUMN GLEN CIR
VICTOR, ID
ZIP 83455
|
| Practice Location Phone Number |
(208) 201-4774 |
| Provider Taxonomy Code |
363LF0000X - Nurse Practitioner |
| Specialization |
Family |
| Provider Enumeration Date |
6/16/2011 |
| Last Update Date |
6/24/2011 |
NPI Number 1023303260 is assigned to an individual registered under the provider name MRS. SUSAN WARD, NP-C .
The NPPES NPI record indicates the provider is a female.
The provider is physically located at:
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:
| 1 |
363LF0000X |
Nurse Practitioner |
Family |
20778.1114 |
WY |
View Code |
| 2 |
363LF0000X |
Nurse Practitioner |
Family |
NP-1071A |
ID |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
NPI Record
| 1 |
NPI |
1023303260 |
| 2 |
Entity Type Code |
1 |
| 3 |
Provider Last Name Legal Name |
WARD |
| 4 |
Provider First Name |
SUSAN |
| 5 |
Provider Name Prefix Text |
MRS. |
| 6 |
Provider Credential Text |
NP-C |
| 7 |
Provider First Line Business Practice Location Address |
1906 AUTUMN GLEN CIR |
| 8 |
Provider Business Practice Location Address City Name |
VICTOR |
| 9 |
Provider Business Practice Location Address State Name |
ID |
| 10 |
Provider Business Practice Location Address Postal Code |
834554629 |
| 11 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 12 |
Provider Business Practice Location Address Telephone Number |
2082014774 |
| 13 |
Provider Enumeration Date |
6/16/2011 |
| 14 |
Last Update Date |
6/24/2011 |
| 15 |
Provider Gender Code |
F |
| 16 |
Healthcare Provider Taxonomy Code 1 |
363LF0000X |
| 17 |
Provider License Number 1 |
20778.1114 |
| 18 |
Provider License Number State Code 1 |
WY |
| 19 |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
| 20 |
Healthcare Provider Taxonomy Code 2 |
363LF0000X |
| 21 |
Provider License Number 2 |
NP-1071A |
| 22 |
Provider License Number State Code 2 |
ID |
| 23 |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
| 24 |
Is Sole Proprietor |
Y |
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This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.