Provider Demographics
NPI:1881676328
Name:LAI, SUSAN SWEE GAIK (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SWEE GAIK
Last Name:LAI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-332-6015
Practice Address - Street 1:800 5TH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7305
Practice Address - Country:US
Practice Address - Phone:817-332-6092
Practice Address - Fax:817-332-6015
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438402363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159875701Medicaid
P00027581OtherRAILROAD MEDICARE