Doctor Name: | SUSAN KAY BLOCK |
NPI Number: | 1346200417 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | N.P. |
License Number: | 102510 |
Business Practice Address: | 113 Lielmanis Ave Hurlburt Field, FL - 325445613 |
Business Phone Number: | 8508811653 |
Business Fax Number: | |
Mailing Address: | 655 Bens Ln, EGLIN AFB |
State: | FL |
Postal Code: | 325421503 |
Phone Number: | 8508811653 |
Fax Number: | |
NPI Enumeration Date: | 03/24/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 102510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |