Provider Demographics
NPI:1245348267
Name:MOORE, SUSAN M (APRN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1418 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3544
Mailing Address - Country:US
Mailing Address - Phone:785-229-3561
Mailing Address - Fax:785-229-3529
Practice Address - Street 1:1418 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3544
Practice Address - Country:US
Practice Address - Phone:785-229-3561
Practice Address - Fax:785-229-3529
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45833363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161874Medicare Oscar/Certification
KS161874Medicare Oscar/Certification