Susan Marie Doepker, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

28099733A Issued in IN

Practice address

611 E Douglas Rd Ste 309
Mishawaka, IN 46545-1467

Phone

(574) 335-6232

Fax

(574) 335-0776

NPI assigned

Sep 10, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1093364259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-8717",
            "fax_number": "574-335-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 309",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451467",
            "telephone_number": "574-335-6232",
            "fax_number": "574-335-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOEPKER",
        "first_name": "SUSAN",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-10",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28099733A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.