Provider Demographics
NPI:1295788271
Name:HALBRITTER, SUSAN J (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:HALBRITTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-8000
Mailing Address - Fax:605-328-8001
Practice Address - Street 1:1309 W 17TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-8805
Practice Address - Country:US
Practice Address - Phone:605-328-8000
Practice Address - Fax:605-328-8001
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR018015363L00000X
SDCP000178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00332885Medicare PIN
SDS101192Medicare PIN