Provider Demographics
NPI:1558379735
Name:VOSS, SUSAN T (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:VOSS
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:163 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6884
Mailing Address - Country:US
Mailing Address - Phone:573-719-1818
Mailing Address - Fax:573-719-1818
Practice Address - Street 1:211 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISIANA
Practice Address - State:MO
Practice Address - Zip Code:63353-2000
Practice Address - Country:US
Practice Address - Phone:573-754-5555
Practice Address - Fax:573-754-4077
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2018-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MORN104354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO134570008Medicare PIN
MOS68984Medicare UPIN