Basic Information
| Provider Information | |||||||||
| NPI: | 1053417857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSFORD-ORSBURN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HANSFORD | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 115 E BYPASS 287 | ||||||||
| Address2: | |||||||||
| City: | ALVORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762257778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404272858 | ||||||||
| FaxNumber: | 9406277464 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 E BYPASS 287 | ||||||||
| Address2: | |||||||||
| City: | ALVORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762257778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404282858 | ||||||||
| FaxNumber: | 8662412533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP106807 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | AP106807 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207Q00000X | 254192 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 254192 | 01 | TX | LICENSE | OTHER |