Provider Demographics
NPI:1790732626
Name:MOURS, SUSAN G (APNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:MOURS
Suffix:
Gender:F
Credentials:APNP
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Mailing Address - Street 1:W232N7970 NESTING CT
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-5702
Mailing Address - Country:US
Mailing Address - Phone:262-818-4228
Mailing Address - Fax:262-653-5412
Practice Address - Street 1:400 WOODLAND PRIME
Practice Address - Street 2:N74W12501 LEATHERWOOD COURT
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4490
Practice Address - Country:US
Practice Address - Phone:414-777-0811
Practice Address - Fax:414-777-3529
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2019-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1038363LA2200X
WI1038-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43894500Medicaid
WI43894500Medicaid