Provider Demographics
NPI:1184783482
Name:WINDHAM, SUSAN J (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 908
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-2086
Mailing Address - Country:US
Mailing Address - Phone:205-344-9393
Mailing Address - Fax:205-759-7744
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 908
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-344-9393
Practice Address - Fax:205-759-7744
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1043954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I500294OtherMEDICARE
AL051040513OtherBCBS OF ALABAMA
AL103896Medicaid
ALS62707Medicare UPIN