Provider Demographics
NPI:1720192073
Name:BOHNSTEDT, SUSAN N (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:N
Last Name:BOHNSTEDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:N
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13401 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-1408
Mailing Address - Country:US
Mailing Address - Phone:405-252-3450
Mailing Address - Fax:405-252-3499
Practice Address - Street 1:13401 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1408
Practice Address - Country:US
Practice Address - Phone:405-252-3450
Practice Address - Fax:405-252-3499
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant