Provider Demographics
NPI:1750182770
Name:TRUONG, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TRUONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 SOARING EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5996
Mailing Address - Country:US
Mailing Address - Phone:773-656-7993
Mailing Address - Fax:
Practice Address - Street 1:1456 SOARING EAGLE DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5996
Practice Address - Country:US
Practice Address - Phone:773-656-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025009331363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner