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NPI Code Detail

MEDICARE: SUSAN PRAYTER NP

MEDICARE: SUSAN PRAYTER NP
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 PractitionerRN094003GA

General Provider Information

NPI Number : 1811132301
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN PRAYTER NP
Provider Business Mailing Address
First Line : 4165 30TH AVE S STE 101
Second Line :
City : FARGO
State : ND
Zip : 58104-8419
Country : US
Telephone Number : 701-492-7214
Fax Number : 866-397-7399
Provider Business Practice Location Address
First Line : 5230 DALLAS HWY
Second Line :
City : POWDER SPRINGS
State : GA
Zip : 30127-4263
Country : US
Telephone Number : 866-825-3227
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2008
Last Update Date : 12/11/2008

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