Provider Demographics
NPI:1417315557
Name:CROFT, SUSIE (RN, ND,)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:
Last Name:CROFT
Suffix:
Gender:F
Credentials:RN, ND,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2384 E STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5701
Mailing Address - Country:US
Mailing Address - Phone:254-338-4893
Mailing Address - Fax:
Practice Address - Street 1:2384 E STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5701
Practice Address - Country:US
Practice Address - Phone:254-338-4893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529923163W00000X
171M00000X, 173C00000X, 174H00000X
DC175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No173C00000XOther Service ProvidersReflexologist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath