Provider Demographics
NPI:1255449054
Name:ANDERSEN, SUSAN ELAINE (ARNP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-1612
Mailing Address - Country:US
Mailing Address - Phone:785-749-3324
Mailing Address - Fax:
Practice Address - Street 1:1920 MOODIE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3166
Practice Address - Country:US
Practice Address - Phone:785-766-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45926363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health