Healthcare Provider Details

I. General information

NPI: 1013904960
Provider Name (Legal Business Name): SUSAN HASSELLE MS, ARNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MASSACHUSETTS ST
LAWRENCE KS
66044-2868
US

IV. Provider business mailing address

1571 N 962 RD
LAWRENCE KS
66046-9224
US

V. Phone/Fax

Practice location:
  • Phone: 785-865-2400
  • Fax: 785-865-0014
Mailing address:
  • Phone: 785-842-9138
  • Fax: 785-865-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number74031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: