Provider Demographics
NPI:1184270241
Name:LEWIS, SUSANNA SQUYRES (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:SQUYRES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:CHRISTINE
Other - Last Name:SQUYRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 2475
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2475
Mailing Address - Country:US
Mailing Address - Phone:318-238-5300
Mailing Address - Fax:318-238-5301
Practice Address - Street 1:740 KEYSER AVE STE E
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6083
Practice Address - Country:US
Practice Address - Phone:318-238-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2514342Medicaid