Provider Demographics
NPI:1821056797
Name:GEORGE, SUSAN R (PA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9300 E 29TH ST N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2182
Mailing Address - Country:US
Mailing Address - Phone:316-858-9000
Mailing Address - Fax:316-858-9005
Practice Address - Street 1:9300 E 29TH ST N
Practice Address - Street 2:SUITE 310
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2182
Practice Address - Country:US
Practice Address - Phone:316-858-9000
Practice Address - Fax:316-858-9005
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15000887363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P98891Medicare UPIN
KS042037Medicare ID - Type Unspecified