Provider Demographics
NPI:1417047861
Name:BARTLEIN, SUSAN ELEANOR (ANP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ELEANOR
Last Name:BARTLEIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ELEANOR
Other - Last Name:MCKEOWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:910 E. PARADISE DR.
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-5451
Mailing Address - Country:US
Mailing Address - Phone:262-338-5933
Mailing Address - Fax:262-334-1620
Practice Address - Street 1:910 E PARADISE DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5451
Practice Address - Country:US
Practice Address - Phone:262-338-5933
Practice Address - Fax:262-334-1620
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1472033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health