Provider Demographics
NPI:1992793723
Name:CROSS, SUSAN L (ARNP, BC-ADM)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:CROSS
Suffix:
Gender:F
Credentials:ARNP, BC-ADM
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:DAVIS THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, BC-ADM
Mailing Address - Street 1:2213 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5305
Mailing Address - Country:US
Mailing Address - Phone:515-237-3974
Mailing Address - Fax:515-883-2692
Practice Address - Street 1:2480 BERKSHIRE PKWY
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4683
Practice Address - Country:US
Practice Address - Phone:515-987-5188
Practice Address - Fax:515-987-8152
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA059121363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1649560236OtherBCBS
IAIB2663001Medicare PIN
IA46951Medicare ID - Type Unspecified