Provider Demographics
NPI:1013913805
Name:FOGGER, SUSANNE EILEEN (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:EILEEN
Last Name:FOGGER
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:908 20TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2610
Practice Address - Country:US
Practice Address - Phone:205-934-1917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1090016363LA2200X
FLARNP9176788363LP0808X
AL1-090016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051115546OtherBCBS
AL127930Medicaid
MS03930867Medicaid
AL051115548OtherBCBS
AL051115547OtherBCBS
AL130733Medicaid
AL051115544OtherBCBS
AL127933Medicaid
AL102I504368Medicare PIN
AL130733Medicaid