Provider Demographics
NPI:1285830802
Name:SCHOLZ, SUSAN E (CFNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SCHOLZ
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ALPINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462
Mailing Address - Country:US
Mailing Address - Phone:903-784-8300
Mailing Address - Fax:903-785-7050
Practice Address - Street 1:2745 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3427
Practice Address - Country:US
Practice Address - Phone:903-784-8300
Practice Address - Fax:903-785-7050
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX566966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0929242-04Medicaid
TX0929242-03Medicaid
TXNP0287Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
TX0929242-03Medicaid