Susana Donofry, DNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Fairbanks, AK
NPI 1043706245 · NPPES record last updated May 14, 2022
Key facts
- NPI
- 1043706245
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 134550 (AK)
- Practice address
- 565 University Ave Ste 1
Fairbanks, AK 99709 - Phone
- (215) 704-1238
- NPI assigned
- Jul 11, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NURR32974 | AK | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | 134550 | AK | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 134550 | AK | Yes |
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | NURR32974 | AK |
Addresses
Primary practice location
565 University Ave Ste 1
Fairbanks, AK 99709
Mailing address
PO Box 61009
Fairbanks, AK 99706-1009
Other providers in Fairbanks, AK
- Perry Levi Dominick
- Stefanie Lyn Donahue
- Carly Donald
- Lisa Jean Donat
- Kaitln Donnelly
- Shelly Donoghue
- Valerie Renee Dorsch
- Monique Dorsey
- Robert Richard Dorton
- Virginia Paige Dougherty
All providers in Fairbanks, AK · Psychiatric/Mental Health Nurse Practitioner in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.