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General NPI Number Information
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NPI Number | 1194285759
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Entity Type | Individual
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Provider Name | SUSAN E. NOURSE MD
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Gender | Female
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 901 E 2ND ST STE 300
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City | RENO
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State | NV
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Zip | 89502-1175
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Country | US
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Telephone | 801-581-5501
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 MILL ST # M14
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City | RENO
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State | NV
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Zip | 89502-1576
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Country | US
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Telephone | 757-982-5262
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Fax |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 11901394-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 26887
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License Number State | NV
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