Basic Information
| Provider Information | |||||||||
| NPI: | 1760522064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERSIG | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ELENA | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13214 EDISON TRACE LN | ||||||||
| Address2: | |||||||||
| City: | TOMBALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773772077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6787773455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12015 LOUETTA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770701148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816642152 | ||||||||
| FaxNumber: | 2812573514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 11/18/2014 | ||||||||
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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 | 864300 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1447372123 | 01 | TX | TXHSTPS NPI | OTHER | 1083752059 | 01 | TX | ACUTE NPI | OTHER | 1760522064 | 01 | TX | NPI | OTHER |