Healthcare Provider Details

I. General information

NPI: 1366730483
Provider Name (Legal Business Name): SUZANNE PETERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE DUNN

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 03/31/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13920 HIGHWAY 59
ERIE KS
66733-5001
US

IV. Provider business mailing address

629 S PLUMMER AVE PO BOX 426
CHANUTE KS
66720-1928
US

V. Phone/Fax

Practice location:
  • Phone: 620-244-5105
  • Fax: 620-244-5111
Mailing address:
  • Phone: 620-431-4000
  • Fax: 620-431-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number75493
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-055412-061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: