Provider Demographics
NPI:1760786750
Name:HERSHEY, SUSAN MARIE (RN, MS, CPNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HERSHEY
Suffix:
Gender:F
Credentials:RN, MS, CPNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4201 BEE CAVES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6465
Mailing Address - Country:US
Mailing Address - Phone:512-327-1155
Mailing Address - Fax:512-327-1156
Practice Address - Street 1:4201 BEE CAVES RD STE 100
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:512-327-1155
Practice Address - Fax:512-327-1156
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX557149363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics