MEDICARE: SUSAN PAULINE MCQUADE FNP

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	363LF0000X	Family Nurse Practitioner	523832	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0021NP	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1982892790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PAULINE MCQUADE FNP

Provider Business Mailing Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:	SUITE 200
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-263-9188
Fax Number	:	512-263-3645

Provider Business Practice Location Address
First Line	:	1927 LOHMANS CROSSING RD
Second Line	:	SUITE 200
City	:	LAKEWAY
State	:	TX
Zip	:	78734-5239
Country	:	US
Telephone Number	:	512-263-9188
Fax Number	:	512-263-3645

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

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	01/18/2010

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