Healthcare Provider Details

I. General information

NPI: 1952974172
Provider Name (Legal Business Name): SUSAN ZHOU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SONG YING WU RN

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 8TH ST
COFFEYVILLE KS
67337-4109
US

IV. Provider business mailing address

PO BOX 1832
PITTSBURG KS
66762-1832
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-9170
  • Fax:
Mailing address:
  • Phone: 888-777-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021047214
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0084346
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number80670
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: