Provider Demographics
NPI:1982892790
Name:MCQUADE, SUSAN PAULINE (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAULINE
Last Name:MCQUADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:PAULINE
Other - Last Name:MCQUADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRNBC
Mailing Address - Street 1:1927 LOHMANS CROSSING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5239
Mailing Address - Country:US
Mailing Address - Phone:512-263-9188
Mailing Address - Fax:512-263-3645
Practice Address - Street 1:1927 LOHMANS CROSSING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5239
Practice Address - Country:US
Practice Address - Phone:512-263-9188
Practice Address - Fax:512-263-3645
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX523832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021NPOtherBCBS