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
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: 11/14/2014
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.