Provider Demographics
NPI:1962408195
Name:VOGELSMEIER, SUZANNE MARIE (APRN, BC, MSN, CWS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:VOGELSMEIER
Suffix:
Gender:F
Credentials:APRN, BC, MSN, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 SOUTH 65 HIGHWAY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3702
Mailing Address - Country:US
Mailing Address - Phone:660-831-3553
Mailing Address - Fax:660-831-3325
Practice Address - Street 1:2305 SOUTH 65 HIGHWAY
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3702
Practice Address - Country:US
Practice Address - Phone:660-831-3553
Practice Address - Fax:660-831-3325
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109128363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425098431Medicaid
MO1962408195Medicaid
P10666Medicare UPIN
MO000082157Medicare ID - Type Unspecified
MOS39A483Medicare PIN
KSS39A483AMedicare PIN
MOMA1084Medicare PIN
E2900001Medicare PIN
MO1962408195Medicaid
MOMA1087001Medicare PIN