MEDICARE: MRS. SUSAN M HOSSLER RN, MSN, PNP

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
1	174400000X	Specialist		TN

General Provider Information

NPI Number	:	1659369882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN M HOSSLER RN, MSN, PNP

Provider Business Mailing Address
First Line	:	2219 LAKELAND DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2043
Country	:	US
Telephone Number	:	423-928-9007
Fax Number	:	423-928-9249

Provider Business Practice Location Address
First Line	:	302 WESLEY ST
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1741
Country	:	US
Telephone Number	:	423-928-9007
Fax Number	:	423-928-9249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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