Basic Information
| Provider Information | |||||||||
| NPI: | 1902957616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORDHUES | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | JEANNE | ||||||||
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| Credential: | RN,MSN,ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5501 NW 62ND TER | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641512408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165848884 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 N CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640687129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167811696 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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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 | 363LA2200X | 53-45989-012 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LA2200X | 140573 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 161860 | 01 | KS | BCBS KS OUTREACH CLINICS | OTHER | 200536020A | 05 | KS | MEDICAID | 1902957616 | 01 | MO | COMMUNITY HEALTH PLAN | OTHER | 200536020B | 05 | KS | MEDICAID |