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General NPI Number Information
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NPI Number | 1104845072
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Entity Type | Individual
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Provider Name | SUZANNE MARIE EARL APRN,BC,FNP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 4900 ST HWY. 160 SUITE 2
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City | THEODOSIA
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State | MO
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Zip | 65761-6539
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Country | US
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Telephone | 417-273-2300
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Fax | 417-273-2316
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Provider Business Mailing Address
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Address Line | PO BOX 328 4900 ST. HWY 160 SUITE 2
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City | THEODOSIA
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State | MO
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Zip | 65761-0328
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Country | US
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Telephone | 417-273-2300
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Fax | 417-273-2316
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 074879
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License Number State | MO
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