Provider Demographics
NPI:1013904960
Name:HASSELLE, SUSAN (MS, ARNP, CNS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HASSELLE
Suffix:
Gender:F
Credentials:MS, ARNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 N 962 RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-9224
Mailing Address - Country:US
Mailing Address - Phone:785-842-9138
Mailing Address - Fax:785-865-0014
Practice Address - Street 1:900 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2868
Practice Address - Country:US
Practice Address - Phone:785-865-2400
Practice Address - Fax:785-865-0014
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74031364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
62-60238OtherUNITED HEALTHCARE
KS010500OtherBC/BS
KS010500OtherBC/BS