Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 20778.1114 | WY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP-1071A | ID |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP4797 | AZ |
NPI | 1023303260 |
---|---|
Provider Name | Mrs. Susan Ward |
First Address | Victor, ID 83455-4629 |
Second Address | Victor, ID 83455-4629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2011 |
Last Update Date | 06/01/2017 |