Provider Demographics
NPI:1740249481
Name:GIVEN, SUSAN LEWIS (MPAS, PAC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEWIS
Last Name:GIVEN
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Gender:F
Credentials:MPAS, PAC
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Mailing Address - Street 1:1 MED CENTER DR
Mailing Address - Street 2:LOUIS A. JOHNSON VA MEDICAL CENTER
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4155
Mailing Address - Country:US
Mailing Address - Phone:304-623-3461
Mailing Address - Fax:304-626-7724
Practice Address - Street 1:1 MED CENTER DR
Practice Address - Street 2:LOUIS A. JOHNSON VA MEDICAL CENTER
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4155
Practice Address - Country:US
Practice Address - Phone:304-623-3461
Practice Address - Fax:304-626-7724
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WV740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant