Provider Demographics
NPI:1407886005
Name:LINAN, SUSAN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:LINAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 S KIRKWOOD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6161
Mailing Address - Country:US
Mailing Address - Phone:314-909-1666
Mailing Address - Fax:314-909-7406
Practice Address - Street 1:333 S KIRKWOOD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-6161
Practice Address - Country:US
Practice Address - Phone:314-909-1666
Practice Address - Fax:314-909-7406
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102812363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO331125OtherHEALTHLINK
MO152148OtherBLUE CROSS BLUE SHIELD
MO5261568OtherAETNA
MO000097048Medicare PIN
S29861Medicare UPIN