Provider Demographics
NPI:1588611966
Name:DEAL, SUSAN J (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:DEAL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4617
Mailing Address - Country:US
Mailing Address - Phone:308-632-7322
Mailing Address - Fax:308-632-6181
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 2250
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4617
Practice Address - Country:US
Practice Address - Phone:308-632-7322
Practice Address - Fax:308-632-6181
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2018-01-03
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Provider Licenses
StateLicense IDTaxonomies
NE921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47060454200Medicaid
NE47060454200Medicaid
NENA1214040Medicare PIN