Provider Demographics
NPI:1962786368
Name:POPE, SUSAN THERESE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:THERESE
Last Name:POPE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 ABBOTTS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3757
Mailing Address - Country:US
Mailing Address - Phone:336-391-5894
Mailing Address - Fax:
Practice Address - Street 1:1420 WESTOVER TER
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2007
Practice Address - Country:US
Practice Address - Phone:336-808-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC230964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily