Provider Demographics
NPI:1588663405
Name:IFFRIG, SUSAN J (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:IFFRIG
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:102 FAWN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-5943
Mailing Address - Country:US
Mailing Address - Phone:636-219-3067
Mailing Address - Fax:
Practice Address - Street 1:1901 TRADE CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1262
Practice Address - Country:US
Practice Address - Phone:636-978-1610
Practice Address - Fax:636-978-1926
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO102332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP1341Medicare UPIN