Provider Demographics
NPI:1942391446
Name:WILHELM, SUSAN ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:WILHELM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ORTEGO
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:16421 DETRAZ RD
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-8651
Mailing Address - Country:US
Mailing Address - Phone:337-893-4148
Mailing Address - Fax:
Practice Address - Street 1:1125 MARGUERITE ST
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1855
Practice Address - Country:US
Practice Address - Phone:985-384-2200
Practice Address - Fax:985-380-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1622079Medicaid
LA1622079Medicaid
LAQ31324Medicare UPIN