Suzette Denise Vandivier, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA.0004054 Issued in CO

Practice address

1124 E Elizabeth St
Fort Collins, CO 80524-4052

Phone

(970) 484-0798

Fax

(970) 482-0679

NPI assigned

Sep 17, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1410912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1477955870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1124 E ELIZABETH ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244052",
            "telephone_number": "970-484-0798",
            "fax_number": "970-482-0679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 E ELIZABETH ST",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244052",
            "telephone_number": "970-484-0798",
            "fax_number": "970-482-0679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDIVIER",
        "first_name": "SUZETTE",
        "middle_name": "DENISE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-17",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CO",
            "license": "PA.0004054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Vander Leest, ,MACP, ADDC
• Shonny H Vander Vliet, ATC
• Christina Vanderbeek, LPC, MA
• Jay Vanderwerff, LCSW, LAC
• Karen M Vandewege, R.N.,BSN
• Cynthia K Vanfarowe, M.D.
• Katie Vangraefschepe
• Brandon Vanhessche, D.O.
• Melanie A Vanhook, M.S.N., F.N.P
• Sarah Vannatta, MA, LPCC

• Medical Physician Assistant in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Medical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; 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.