Provider Demographics
NPI:1366409179
Name:DAUWALDER, SUSAN ELAINE (FNP-C PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:DAUWALDER
Suffix:
Gender:F
Credentials:FNP-C PMHNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELAINE
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C PMHNP-BC
Mailing Address - Street 1:1211 21ST AVENUE SOUTH
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-1343
Mailing Address - Country:US
Mailing Address - Phone:615-936-3767
Mailing Address - Fax:615-936-0966
Practice Address - Street 1:1211 21ST AVENUE SOUTH
Practice Address - Street 2:SUITE 112
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-1343
Practice Address - Country:US
Practice Address - Phone:615-936-3767
Practice Address - Fax:615-936-0966
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6679363LP0808X
TNAPN0000006679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S96619Medicare UPIN
3642696Medicare ID - Type Unspecified