1942391446 NPI number — MRS. SUSAN ANN WILHELM FNP

Table of content: MRS. SUSAN ANN WILHELM FNP (NPI 1942391446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942391446 NPI number — MRS. SUSAN ANN WILHELM FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILHELM
Provider First Name:
SUSAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILHELM
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ORTEGO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942391446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16421 DETRAZ RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABBEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70510-8651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-893-4148
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 MARGUERITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGAN CITY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70380-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-384-2200
Provider Business Practice Location Address Fax Number:
985-380-4569
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  APO4416 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1622079 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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