Basic Information
| Provider Information | |||||||||
| NPI: | 1033449921 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVANTS | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RENE' | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 MERIT DR STE 1610 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752512204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171911 | ||||||||
| FaxNumber: | 2142171912 | ||||||||
| Practice Location | |||||||||
| Address1: | 12221 MERIT DR STE 1610 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752512204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142171911 | ||||||||
| FaxNumber: | 2142171912 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2009 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 653558 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | AP113192 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.