Provider Demographics
NPI:1851586713
Name:ZWIASKA, SUSAN CAROL (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:ZWIASKA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:CAROL
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2012 S PROMENADE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9073
Mailing Address - Country:US
Mailing Address - Phone:479-616-1485
Mailing Address - Fax:479-239-0536
Practice Address - Street 1:2012 S PROMENADE BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9073
Practice Address - Country:US
Practice Address - Phone:479-616-1485
Practice Address - Fax:479-239-0536
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1941363AM0700X
ARPT2020-003363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1019178Medicaid
LA1019178Medicaid