Provider Demographics
NPI:1831589977
Name:FOX, SUZANNE (PNP, PMHS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:PNP, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-398-7337
Mailing Address - Fax:
Practice Address - Street 1:6950 E BELLEVIEW AVE STE 300
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1629
Practice Address - Country:US
Practice Address - Phone:303-468-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28206432A363LP0200X, 363LP0808X
IN28206432C363LP0808X
COC-APN.0003511-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics