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General NPI Number Information
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NPI Number | 1982640603
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Entity Type | Individual
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Provider Name | SUSAN D JEWELL APRN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 12/04/2020
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Provider Practice Location Address
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Address Line | 1603 STEVENS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40205-1087
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Country | US
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Telephone | 502-451-5955
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Fax | 502-451-5925
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Provider Business Mailing Address
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Address Line | 2700 STANLEY GAULT PKWY STE 129
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City | LOUISVILLE
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State | KY
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Zip | 40223-5176
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Country | US
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Telephone | 502-253-4917
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Fax | 502-489-5750
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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 | 71001152A
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License Number State | IN
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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 | 3003470
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License Number State | KY
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