Provider Demographics
NPI:1366749764
Name:NORRIS, SUSAN M (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:NORRIS
Suffix:
Gender:F
Credentials:FNP-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 157
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0157
Mailing Address - Country:US
Mailing Address - Phone:573-323-0423
Mailing Address - Fax:573-323-8931
Practice Address - Street 1:17959 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:MO
Practice Address - Zip Code:65466
Practice Address - Country:US
Practice Address - Phone:573-226-5505
Practice Address - Fax:573-226-5584
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011002322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26-8535OtherMEDICARE - RH
MO1366749764Medicaid
MO26D0441751OtherCLIA
MO26D0889777OtherCLIA
MO261816Medicare Oscar/Certification