Healthcare Provider Details

I. General information

NPI: 1912958885
Provider Name (Legal Business Name): SUSAN DUVAL ARNP, CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 3RD AVE
JASPER IN
47546-3602
US

IV. Provider business mailing address

695 3RD AVE
JASPER IN
47546-3602
US

V. Phone/Fax

Practice location:
  • Phone: 812-634-6824
  • Fax: 812-848-2277
Mailing address:
  • Phone: 812-634-6824
  • Fax: 812-848-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3005974
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004303A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: