Provider Demographics
NPI:1558534420
Name:STUDEBAKER, SUSAN SWEENEY (RNC, CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SWEENEY
Last Name:STUDEBAKER
Suffix:
Gender:F
Credentials:RNC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 HIGHWAY 7 E
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-7114
Mailing Address - Country:US
Mailing Address - Phone:281-229-1927
Mailing Address - Fax:
Practice Address - Street 1:3802 HIGHWAY 7 E
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-7114
Practice Address - Country:US
Practice Address - Phone:281-229-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224860363LW0102X, 367A00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife