Provider Demographics
NPI:1669281499
Name:WILSON, SUSAN DIANE
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:STRASBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2536 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1221
Mailing Address - Country:US
Mailing Address - Phone:308-385-5775
Mailing Address - Fax:308-385-5780
Practice Address - Street 1:1519 PARK AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3048
Practice Address - Country:US
Practice Address - Phone:308-385-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion