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General NPI Number Information
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NPI Number | 1447438155
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Entity Type | Individual
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Provider Name | SUSAN MALKEWTIZ VANTREESE ARNP
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Gender | Female
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE ST E207 KENTUCKY CLINIC
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City | LEXINGTON
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State | KY
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Zip | 40536-0084
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Country | US
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Telephone | 859-323-9263
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Fax | 859-323-3704
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Provider Business Mailing Address
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Address Line | 740 S LIMESTONE ST E207 KENTUCKY CLINIC
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City | LEXINGTON
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State | KY
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Zip | 40536-0084
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Country | US
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Telephone | 859-323-9263
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Fax | 859-323-3704
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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 | 659P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1038430
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License Number State | KY
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