Provider Demographics
NPI:1821461500
Name:PREWETT, SUSAN MILLER
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MILLER
Last Name:PREWETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 PLANTATION BLVD
Mailing Address - Street 2:UNIT B
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2949
Mailing Address - Country:US
Mailing Address - Phone:251-732-2635
Mailing Address - Fax:251-732-2637
Practice Address - Street 1:915 PLANTATION BLVD
Practice Address - Street 2:UNIT B
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2949
Practice Address - Country:US
Practice Address - Phone:251-732-2635
Practice Address - Fax:251-732-2637
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113566363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health