Provider Demographics
NPI:1487815726
Name:WARD, SUSAN A (ARNP,CNM)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:WARD
Suffix:
Gender:F
Credentials:ARNP,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4019
Mailing Address - Country:US
Mailing Address - Phone:405-528-4213
Mailing Address - Fax:405-752-6833
Practice Address - Street 1:1508 NW 106TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-5214
Practice Address - Country:US
Practice Address - Phone:405-751-1774
Practice Address - Fax:405-752-6833
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0026912363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100028850Medicaid
OK100028850Medicaid