Healthcare Provider Details

I. General information

NPI: 1487667598
Provider Name (Legal Business Name): SUSAN PRESTON RNC. S, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

IV. Provider business mailing address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

V. Phone/Fax

Practice location:
  • Phone: 325-677-2801
  • Fax:
Mailing address:
  • Phone: 325-677-2801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number224275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: