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NPI Code Detail

MEDICARE: MRS. SUSAN ELIZABETH DEXTER NURSE PRACTITIONER

MEDICARE: MRS. SUSAN ELIZABETH DEXTER NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN-NP148538GA
2163W00000XRegistered NurseRN148538GA

General Provider Information

NPI Number : 1629014030
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN ELIZABETH DEXTER NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 2151 W SPRING ST
Second Line :
City : MONROE
State : GA
Zip : 30655-3202
Country : US
Telephone Number : 770-378-7031
Fax Number :
Provider Business Practice Location Address
First Line : 2151 W SPRING ST
Second Line :
City : MONROE
State : GA
Zip : 30655-3202
Country : US
Telephone Number : 770-267-1789
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2006
Last Update Date : 12/14/2025

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