Healthcare Provider Details

I. General information

NPI: 1972617082
Provider Name (Legal Business Name): SUSAN HANCOCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN WOOTEN NP

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W HWY 6 STE 108
WACO TX
76710-7544
US

IV. Provider business mailing address

611 W HWY 6 STE 108
WACO TX
76710-7544
US

V. Phone/Fax

Practice location:
  • Phone: 254-741-8686
  • Fax: 254-741-8687
Mailing address:
  • Phone: 254-741-8686
  • Fax: 254-741-8687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number255102
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number255102
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: