MEDICARE: SUSAN MARIE BEIDLER PHD MBE CRNP

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	363L00000X	Nurse Practitioner	ARNP9197564	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9197564	FL
3	363LP2300X	Primary Care Nurse Practitioner	ARNP9197564	FL
4	363L00000X	Nurse Practitioner	110924	NE
5	363LF0000X	Family Nurse Practitioner	TP000625B	PA
6	363LF0000X	Family Nurse Practitioner	A138274	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881692473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE BEIDLER PHD MBE CRNP

Provider Business Mailing Address
First Line	:	3303 REBECCA ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2324
Country	:	US
Telephone Number	:	712-279-1793
Fax Number	:	712-279-5299

Provider Business Practice Location Address
First Line	:	3303 REBECCA ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2324
Country	:	US
Telephone Number	:	712-279-1793
Fax Number	:	712-279-5299

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/03/2015

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