Provider Demographics
NPI:1285773358
Name:HUSBAND, SUSAN PAGE OETZEL (NP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAGE OETZEL
Last Name:HUSBAND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39205-0757
Mailing Address - Country:US
Mailing Address - Phone:601-982-1001
Mailing Address - Fax:601-982-1288
Practice Address - Street 1:2906 N STATE ST
Practice Address - Street 2:STE 301
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4233
Practice Address - Country:US
Practice Address - Phone:601-982-1001
Practice Address - Fax:601-982-1288
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0606227363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF0606227OtherCERTIFICATION