Provider Demographics
NPI:1225052426
Name:MANUEL, SUSAN R (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:MANUEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 S. WILLIAM BARNETT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327
Mailing Address - Country:US
Mailing Address - Phone:281-659-2355
Mailing Address - Fax:281-592-1570
Practice Address - Street 1:309 HWY 59 S. LOOP
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:281-659-2355
Practice Address - Fax:281-592-1570
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00280363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00024252Medicare ID - Type UnspecifiedMEDICARE RAILROAD
TXC13534Medicare UPIN
TX00450TMedicare ID - Type Unspecified
278095YQBEMedicare UPIN