Provider Demographics
NPI:1841302759
Name:WILLETTE, SUSAN JANE (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:WILLETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 235TH STREET
Mailing Address - Street 2:
Mailing Address - City:TERRIL
Mailing Address - State:IA
Mailing Address - Zip Code:51364
Mailing Address - Country:US
Mailing Address - Phone:712-320-0807
Mailing Address - Fax:
Practice Address - Street 1:1310 LAKE ST
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1100
Practice Address - Country:US
Practice Address - Phone:712-336-6425
Practice Address - Fax:712-336-6439
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA058734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily