Basic Information
| Provider Information | |||||||||
| NPI: | 1770829012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOCTOLERO | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | NPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3601 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067254721 | ||||||||
| FaxNumber: | 8067236095 | ||||||||
| Practice Location | |||||||||
| Address1: | 3506 21ST ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067251908 | ||||||||
| FaxNumber: | 8067236095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2012 | ||||||||
| LastUpdateDate: | 11/19/2018 | ||||||||
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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 | AP122715 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.