Provider Demographics
NPI:1013933530
Name:STEEN, SUSAN LENORA (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LENORA
Last Name:STEEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 KINGS HWY
Mailing Address - Street 2:DEPARTMENT OF NEUROSURGERY
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-675-6901
Mailing Address - Fax:318-675-4819
Practice Address - Street 1:1501 KINGS HWY
Practice Address - Street 2:DEPARTMENT OF NEUROSURGERY
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-675-6901
Practice Address - Fax:318-675-4819
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA10523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1626872Medicaid
LA1626872Medicaid
LA5D924P435Medicare ID - Type Unspecified