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Individual
SUSAN RAE AULT
Active
Individual
SUSAN RAE AULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
083045668RN
OR
363L00000X
Nurse Practitioner
200450018NP
OR
363LF0000X
Family Nurse Practitioner
Primary
14768
CA
364SX0200X
Oncology Clinical Nurse Specialist
200570025CNS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
GROUP NPI NUMBER
OR
05
—
278215
—
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
08/22/2005
Last updated
05/31/2016
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