Provider Demographics
NPI:1255373007
Name:QUISENBERRY, SUSAN L (APRN-CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:QUISENBERRY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5722
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5722
Mailing Address - Country:US
Mailing Address - Phone:405-702-6700
Mailing Address - Fax:
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-702-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0059860363L00000X
TX705243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200085250AMedicaid
OK200085250AMedicaid