Provider Demographics
NPI:1790767721
Name:AKINS, SUSAN JANE (MSN RN BC AP MHCNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:AKINS
Suffix:
Gender:F
Credentials:MSN RN BC AP MHCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2120 MADISON AVE
Mailing Address - Street 2:STE 404
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4744
Mailing Address - Country:US
Mailing Address - Phone:618-876-7515
Mailing Address - Fax:618-876-7596
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-776-7999
Practice Address - Fax:314-772-2257
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO048345364S00000X
IL209004686364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000081600Medicare ID - Type Unspecified