Provider Demographics
NPI:1417673484
Name:ROJAS, SUSAN OWENS (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:OWENS
Last Name:ROJAS
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 1:3661 SANGANI BLVD SUITE E
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540
Mailing Address - Country:US
Mailing Address - Phone:228-354-0022
Mailing Address - Fax:228-354-0088
Practice Address - Street 1:3661 SANGANI BLVD SUITE E
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540
Practice Address - Country:US
Practice Address - Phone:228-354-0022
Practice Address - Fax:228-354-0088
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905578363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily