Healthcare Provider Details

I. General information

NPI: 1477570398
Provider Name (Legal Business Name): SUZAN OLFERS CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 S WATER ST
BURNET TX
78611-4510
US

IV. Provider business mailing address

PO BOX 1219
BURNET TX
78611-7219
US

V. Phone/Fax

Practice location:
  • Phone: 512-715-3022
  • Fax: 512-756-6405
Mailing address:
  • Phone: 512-715-3022
  • Fax: 512-756-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number226987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: