Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | A-059375 | IA |
N | 363LC1500X | Nurse Practitioner - Community Health | A059375 | IA |
NPI | 1881648756 |
---|---|
Provider Name | Susie Chambers |
First Address | Ottumwa, IA 52501-6414 |
Second Address | Ottumwa, IA 52501-6414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 27/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P34826 | (02) | IA |