Provider Demographics
NPI:1508062001
Name:CHILUKURI, SUSAN BOSS (CPNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BOSS
Last Name:CHILUKURI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PHANTURN LN
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2607
Mailing Address - Country:US
Mailing Address - Phone:713-385-5286
Mailing Address - Fax:
Practice Address - Street 1:5819 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4052
Practice Address - Country:US
Practice Address - Phone:281-499-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678410363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX678410OtherPNP LICENSE