Provider Demographics
NPI:1629265384
Name:PIERSON-SKOOG, SUSANA SL (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:SL
Last Name:PIERSON-SKOOG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SUSANA
Other - Middle Name:SL
Other - Last Name:PIERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:29 ROCKY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3909
Mailing Address - Country:US
Mailing Address - Phone:864-242-3223
Mailing Address - Fax:864-297-9184
Practice Address - Street 1:29 ROCKY SLOPE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3909
Practice Address - Country:US
Practice Address - Phone:864-242-3223
Practice Address - Fax:864-297-9184
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical