Provider Demographics
NPI:1346443777
Name:WANGLER, SUSAN KAY (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:WANGLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 W 141ST ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66537-9444
Mailing Address - Country:US
Mailing Address - Phone:785-338-0031
Mailing Address - Fax:
Practice Address - Street 1:3442 W 141ST ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:KS
Practice Address - Zip Code:66537-9444
Practice Address - Country:US
Practice Address - Phone:785-338-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA0607135363LA2200X
KS75095363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health