Provider Demographics
NPI:1134908106
Name:MOUA, SUSAN S (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:MOUA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 ROCKWELL CHURCH RD NW
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2833
Mailing Address - Country:US
Mailing Address - Phone:678-920-1921
Mailing Address - Fax:
Practice Address - Street 1:3626 OLD OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2805
Practice Address - Country:US
Practice Address - Phone:301-357-9751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN272667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily