Provider Demographics
NPI:1265185961
Name:DORNBUSCH, SUSAN A (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:DORNBUSCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10983 BIGHAM RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:TX
Mailing Address - Zip Code:76579-0210
Mailing Address - Country:US
Mailing Address - Phone:512-736-9059
Mailing Address - Fax:
Practice Address - Street 1:TOTAL MEN'S HEALTH
Practice Address - Street 2:2720 WEST LOOP 340 SUITE 250
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711
Practice Address - Country:US
Practice Address - Phone:512-736-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily