Provider Demographics
NPI:1710975495
Name:KATUIN, SUSAN L (RNC APNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:KATUIN
Suffix:
Gender:F
Credentials:RNC APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:WI
Mailing Address - Zip Code:54155-0365
Mailing Address - Country:US
Mailing Address - Phone:920-869-2711
Mailing Address - Fax:
Practice Address - Street 1:525 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:WI
Practice Address - Zip Code:54155-9035
Practice Address - Country:US
Practice Address - Phone:920-869-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1283-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43832000Medicaid
WI990008817OtherRAILROAD MEDICARE
WI002607270Medicare ID - Type Unspecified
WI43832000Medicaid