=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275675548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN SCHOLZ, FNP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2745 NE LOOP 286
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-3427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-784-8300
-----------------------------------------------------
Fax | 903-785-7050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4125 ALPINE ST
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75462-6674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-784-8300
-----------------------------------------------------
Fax | 903-785-7050
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN E SCHOLZ
-----------------------------------------------------
Credential | CFNP
-----------------------------------------------------
Telephone | 903-784-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 566966
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------