Provider Demographics
NPI:1720006844
Name:JAMES, SUSAN (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 LAIRD AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3734
Mailing Address - Country:US
Mailing Address - Phone:573-364-1033
Mailing Address - Fax:
Practice Address - Street 1:1001 BOWLES AVE
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2338
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:484-351-3800
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP70847Medicare UPIN