Provider Demographics
NPI:1962649384
Name:FIELD, SUSANNA G (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:G
Last Name:FIELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:SUSANNA
Other - Middle Name:G
Other - Last Name:ANGLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-589-8033
Mailing Address - Fax:502-589-0805
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:STE 500
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-589-8033
Practice Address - Fax:502-589-0805
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005923363LF0000X, 363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100111020Medicaid
KY50022929OtherPASSPORT
KY0682420Medicare PIN
9291362OtherAETNA
KY7100111020Medicaid