Provider Demographics
NPI:1104210863
Name:LE, SUSAN THI (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:#335
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:713-771-1100
Mailing Address - Fax:
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:#335
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:713-771-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7529363A00000X
TXPA10283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant