Provider Demographics
NPI:1205834231
Name:WESTER, SUZANNE MICHELLE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:WESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MICHELLE
Other - Last Name:SCHODTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 TRADITIONS WAY
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-7992
Mailing Address - Country:US
Mailing Address - Phone:706-654-3704
Mailing Address - Fax:
Practice Address - Street 1:1340 TRADITIONS WAY
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-7992
Practice Address - Country:US
Practice Address - Phone:706-654-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP29561722367500000X
GARN183826367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306039000Medicaid
FLG2985OtherBCBS OF FL
FLG2985OtherBCBS OF FL