Provider Demographics
NPI:1174567267
Name:SLIEF, SUSAN (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SLIEF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WATSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3068
Mailing Address - Country:US
Mailing Address - Phone:620-672-7422
Mailing Address - Fax:620-450-1601
Practice Address - Street 1:203 WATSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3068
Practice Address - Country:US
Practice Address - Phone:620-672-7422
Practice Address - Fax:620-450-1601
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200002550AMedicaid
KS200002550AMedicaid
KSS27262Medicare UPIN