Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP128126 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP128126 | TX |
NPI | 1073989885 |
---|---|
Provider Name | Susan Ward |
First Address | Harker Heights, TX 76548-6034 |
Second Address | Killeen, TX 76542-6537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2015 |
Last Update Date | 19/10/2015 |