SUSAN K. PETERSON (NPI# 1205946613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205946613 |
| Entity Type | Individual |
| Full Name | SUSAN K. PETERSON |
| Credential | PA |
| Practice Address |
11143 Parkview Plaza Dr 100 Fort Wayne IN 46845-1727 |
| Practice Telephone | 2604848830 |
| Practice Fax Number | 2604831911 |
| Mailing Telephone | 2604848830 |
| Mailing Fax Number | 2604831911 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-10-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
10000342A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | ANTHEM PIN | 000000528371 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801378021 | Susan Nell Peterson | Speech-Language Pathologist | 1045 18th St Sw, Huron, SD 57350-3464 | 2018-09-04 |
| 1366709750 | Susan Harper Peterson | Counselor | 1560 Olympia Cir, #103, Castle Rock, CO 80104-5464 | 2012-04-23 |
| 1972819712 | Susan Karen Peterson | Dietitian, Registered | 3965 Crystal Lake Trl, Faribault, MN 55021-7974 | 2010-08-30 |
| 1255475166 | Susan Peterson | Psychologist | 924 Old Harmony Rd, Suite 201, Newark, DE 19713-4184 | 2007-02-16 |
| 1922178839 | Susan F Peterson | Respiratory Therapist, Registered | 61 Broad Reach, T114-b, North Weymouth, MA 02191-2229 | 2006-11-08 |
| 1104908540 | Susan Peterson | Physical Therapist | 134 Drury Dr, La Plata, MD 20646-4241 | 2006-10-19 |
| 1013014349 | Susan K. Peterson | Social Worker | 1513 25th Ave, Seattle, WA 98122-3017 | 2006-09-20 |
| 1497860480 | Susan A Peterson | Occupational Therapist | 13253 E Playfield Dr, Crestwood, IL 60445 | 2006-08-20 |
| 1003854217 | Susan Mary Peterson | Registered Nurse | 20600 Milton Ct, Brookfield, WI 53045-4020 | 2006-06-02 |
| 1396738803 | Susan Margaret Peterson | Nurse Practitioner | J457 Kentucky Clinic, 740 South Limestone St, Lexington, KY 40536-0284 | 2005-08-30 |
| Street Address |
11143 PARKVIEW PLAZA DR 100 |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46845-1727 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881678860 | Northeast Indiana Genetic Counseling Center Inc | Pediatrics | 11143 Parkview Plaza Dr, Ste. 311, Fort Wayne, IN 46845-1701 | 2005-12-02 |
| 1871014589 | Mindy Harris | Nurse Practitioner | 11143 Parkview Plaza Dr, Fort Wayne, IN 46845-1727 | 2017-07-03 |
| 1629472840 | Alexa A Chapman | Registered Nurse | 11143 Parkview Plaza Dr, Suite 100, Fort Wayne, IN 46845-1727 | 2014-10-17 |
| 1942639216 | Meghan Lundy | Genetic Counselor, MS | 11143 Parkview Plaza Dr, Ste. 311, Fort Wayne, IN 46845-1727 | 2013-11-06 |
| 1255774501 | Kelsey Johnson | Genetic Counselor, MS | 11143 Parkview Plaza Dr, Suite 311, Fort Wayne, IN 46845-1727 | 2013-04-16 |
| 1497058812 | Angela Michelle Bauer | Registered Nurse | 11143 Parkview Plaza Dr, Suite 311, Fort Wayne, IN 46845-1727 | 2010-12-07 |
| 1730289257 | Daniel R Konow | Physician Assistant | 11143 Parkview Plaza Dr, Suite 100, Fort Wayne, IN 46845-1727 | 2006-09-24 |
| 1366422529 | Kenneth Ray Austin | Anesthesiology | 11143 Parkview Plaza Dr, Suite 207, Fort Wayne, IN 46845-1727 | 2006-01-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881154110 | Nancy Jean Ehmke | Clinical Nurse Specialist | 11151 Parkview Plaza Dr, Fort Wayne, IN 46845 | 2019-03-22 |
| 1043703903 | Kara Stackhouse | Nurse Practitioner | 11050 Parkview Plaza Drive, Fort Wayne, IN 46845 | 2018-06-14 |
| 1871082412 | Tara K Jellison | Pharmacist | 11109 Parkview Plaza Drive -- Attn Pharmacy, Fort Wayne, IN 46845 | 2018-05-09 |
| 1578097572 | Forefront Dermatology, S.c. | Dermatology | 4020 New Vision Drive, Fort Wayne, IN 46845 | 2017-04-17 |
| 1811437999 | Jessica Ann Lefever | Behavioral Analyst | 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 | 2017-03-08 |
| 1033668041 | Bhi Home Care, Inc. | In Home Supportive Care | 820 Mill Lake Road, Fort Wayne, IN 46845 | 2016-10-03 |
| 1467814939 | Austin Wyss | Specialist/Technologist | 11130 Parkview Circle Drive, Ft. Wayne, IN 46845 | 2016-03-24 |
| 1154713584 | Ashley Whitcraft | Specialist/Technologist | 11130 Parkview Plaza Drive #4, Fort Wayne, IN 46845 | 2015-02-23 |
| 1275975682 | Lakshmi Mohan Viji Das | Internal Medicine | 11143 Parkview Plaza Dr Ste 311, Fort Wayne, IN 46845 | 2013-07-26 |
| 1336482496 | Mithun Mohana Shenoi | Colon & Rectal Surgery | 11104 Parkview Circle Drive Suite 320, Fort Wayne, IN 46845 | 2013-03-27 |
| Find all providers in zip 46845 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144215153 | Mark A Fisher | Physician Assistant | 1721 Magnavox Way, Fort Wayne, IN 46804-1537 | 2005-09-15 |
| 1275142986 | Bradley Ophoff | Physician Assistant | 1819 Carew St, Fort Wayne, IN 46805-4705 | 2020-07-28 |
| 1073963351 | Jenifer Kay Fortney | Physician Assistant | 5650 Coventry Ln, Fort Wayne, IN 46804-7140 | 2016-06-16 |
| 1972900199 | Rachel Mcpherson | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2014-12-03 |
| 1730581067 | Keith William Lowe | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2014-09-18 |
| 1528321759 | Sarita Ruetz | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2012-06-21 |
| 1760765945 | Jennifer Raye Myers | Physician Assistant | 7333 W Jefferson Blvd, Fort Wayne, IN 46804-6280 | 2011-09-23 |
| 1841421583 | Nathaniel D Roach | Physician Assistant | 5050 N Clinton St, Fort Wayne, IN 46825-5886 | 2009-07-29 |
| 1265678486 | Cheryl Lynn Kiel | Physician Assistant | 11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701 | 2008-12-17 |
| 1407010564 | Emily E Lierman | Physician Assistant | 2200 Randallia Dr., Fort Wayne, IN 46805-4638 | 2008-07-17 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46845 |
Please comment or provide details below to improve the information on SUSAN K. PETERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.