Provider Demographics
NPI:1720088727
Name:SCOTT, SUSAN MILLS (CRNA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MILLS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8550 DATAPOINT DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3270
Mailing Address - Country:US
Mailing Address - Phone:210-615-7232
Mailing Address - Fax:210-615-6732
Practice Address - Street 1:8550 DATAPOINT DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-615-7232
Practice Address - Fax:210-615-6732
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX740522163W00000X
TX045099 AANA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289647401Medicaid
TX289647401Medicaid