Provider Demographics
NPI:1558324533
Name:TROUTMAN, SUSAN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:TROUTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1985 TATE BLVD SE
Mailing Address - Street 2:SUITE 757
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1469
Mailing Address - Country:US
Mailing Address - Phone:828-320-0733
Mailing Address - Fax:828-322-4374
Practice Address - Street 1:1985 TATE BLVD SE
Practice Address - Street 2:SUITE 757
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1469
Practice Address - Country:US
Practice Address - Phone:828-320-0733
Practice Address - Fax:828-322-4374
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001107363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592595Medicare PIN
NCQ65102Medicare UPIN