Provider Demographics
NPI:1013186972
Name:HANOBECK VERVILLE, SUSAN ANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNE
Last Name:HANOBECK VERVILLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ANNE
Other - Last Name:HANOBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 60799
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0799
Mailing Address - Country:US
Mailing Address - Phone:704-282-0488
Mailing Address - Fax:
Practice Address - Street 1:1303 DOVE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5012
Practice Address - Country:US
Practice Address - Phone:704-282-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004119Medicaid
NC7004119Medicaid