Provider Demographics
NPI:1023422342
Name:CLOSE, SUSAN (FNP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CLOSE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:WINEGARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2614 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-4206
Mailing Address - Country:US
Mailing Address - Phone:660-679-1301
Mailing Address - Fax:
Practice Address - Street 1:901 NE RIVER RD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66616-1142
Practice Address - Country:US
Practice Address - Phone:660-679-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014004539363LF0000X
KS53-76317-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily