Provider Demographics
NPI:1790334894
Name:HALLQUIST, SUZANNE PROCTOR (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PROCTOR
Last Name:HALLQUIST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N FIELDS CIR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4332
Mailing Address - Country:US
Mailing Address - Phone:919-381-0897
Mailing Address - Fax:
Practice Address - Street 1:234 CROOKED CREEK PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8506
Practice Address - Country:US
Practice Address - Phone:919-590-0157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09418363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical