Basic Information
| Provider Information | |||||||||
| NPI: | 1386613040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOBLETT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 COLLEGE AVE | ||||||||
| Address2: | SUITE E-110 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855372651 | ||||||||
| FaxNumber: | 7855374276 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 COLLEGE AVE | ||||||||
| Address2: | SUITE E-110 | ||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855372651 | ||||||||
| FaxNumber: | 7855372975 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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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 | 363L00000X | 74497 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 100395280A | 05 | KS | MEDICAID | 068002180 | 01 | KS | MEDICARE PTAN | OTHER | 100395280B | 05 | KS | MEDICAID |