Provider Demographics
NPI:1770829012
Name:DOCTOLERO, SUSAN (NPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DOCTOLERO
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-0002
Mailing Address - Country:US
Mailing Address - Phone:806-725-4721
Mailing Address - Fax:806-723-6095
Practice Address - Street 1:3506 21ST ST
Practice Address - Street 2:SUITE 302
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1212
Practice Address - Country:US
Practice Address - Phone:806-725-1908
Practice Address - Fax:806-723-6095
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122715363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner