Provider Demographics
NPI:1659544179
Name:SASS-DERUYTER, SUZANNE M (APNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:SASS-DERUYTER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APNP
Mailing Address - Street 1:725 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-928-4780
Mailing Address - Fax:262-928-5588
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-4780
Practice Address - Fax:262-928-5588
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3317-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner