Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 1-090016 | AL |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | ARNP9176788 | FL |
NPI | 1013913805 |
---|---|
Provider Name | Susanne Eileen Fogger |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35205-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2005 |
Last Update Date | 23/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03930867 | (05) | MS |
051115544 | BCBS (01) | AL |
051115546 | BCBS (01) | AL |
051115547 | BCBS (01) | AL |
051115548 | BCBS (01) | AL |
127930 | (05) | AL |
127933 | (05) | AL |
130733 | (05) | AL |