Susan Gayle Polk, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

14-97418-081 Issued in KS

Practice address

550 Pope Ave
Munson Army Health Center Attn MCXN-Cod, Ms Cotton
Fort Leavenworth, KS 66027-2332

Phone

(913) 684-6562

Fax

(913) 684-6208

NPI assigned

Nov 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Other names 1

• Susan Gayle Hanegan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679647812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 BROOKWOOD ST",
            "city": "LANSING",
            "state": "KS",
            "postal_code": "660431488",
            "telephone_number": "913-727-5283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 POPE AVE",
            "address_2": "MUNSON ARMY HEALTH CENTER ATTN MCXN-COD, MS COTTON",
            "city": "FORT LEAVENWORTH",
            "state": "KS",
            "postal_code": "660272332",
            "telephone_number": "913-684-6562",
            "fax_number": "913-684-6208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "SUSAN",
        "middle_name": "GAYLE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "14-97418-081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HANEGAN",
            "middle_name": "GAYLE",
            "credential": "RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jacqueline Sue Perdue-Dorathy, LPN
• Eduardo Miguel Perez, LPN
• Robert Louis Petrone, PH.D., MPH, PA-C
• Courtney Pippin, PSYD
• Barry Robert Pockrandt, MD
• Ryan Blake Province, PHARMD
• Karolina Przegienda, PSY.D
• Michelle Ralph, RDH
• Thomas Rawlings, RN
• Courtney Raynes

• Registered Nurse in Fort Leavenworth, KS
• Providers in Fort Leavenworth, KS by specialty
• Registered Nurse in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.