Provider Demographics
NPI:1104845072
Name:EARL, SUZANNE MARIE (APRN,BC,FNP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:EARL
Suffix:
Gender:F
Credentials:APRN,BC,FNP
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Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:4900 ST. HWY 160 SUITE 2
Mailing Address - City:THEODOSIA
Mailing Address - State:MO
Mailing Address - Zip Code:65761-0328
Mailing Address - Country:US
Mailing Address - Phone:417-273-2300
Mailing Address - Fax:417-273-2316
Practice Address - Street 1:4900 ST HWY. 160
Practice Address - Street 2:SUITE 2
Practice Address - City:THEODOSIA
Practice Address - State:MO
Practice Address - Zip Code:65761-6539
Practice Address - Country:US
Practice Address - Phone:417-273-2300
Practice Address - Fax:417-273-2316
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO074879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427550306Medicaid