Basic Information
| Provider Information | |||||||||
| NPI: | 1881676328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAI | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | SWEE GAIK | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 961205 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761611205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177408400 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 5TH AVE | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761047305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173326092 | ||||||||
| FaxNumber: | 8173326015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 02/18/2010 | ||||||||
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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 | 438402 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 159875701 | 05 | TX | MEDICAID | P00027581 | 01 | RAILROAD MEDICARE | OTHER |