Provider Demographics
NPI:1265786271
Name:JOHN, SUJI ANN (CPNP)
Entity type:Individual
Prefix:MS
First Name:SUJI
Middle Name:ANN
Last Name:JOHN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MS
Other - First Name:SUJI
Other - Middle Name:ANCY
Other - Last Name:YOHANNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:972-832-7591
Mailing Address - Fax:
Practice Address - Street 1:3828 MENARD DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6470
Practice Address - Country:US
Practice Address - Phone:972-832-7591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20122433363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics