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Individual

SUSANNAH HANCOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1189 RED ROBIN AVE, AMMON, ID 83401-5747
(619) 602-4520
Mailing address
784 SOUTH CLEAR LOOP STE R, POST FALLS, ID 83854
(619) 602-4520

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
54459
ID
363LF0000X
Family Nurse Practitioner
95006211
CA

Other

Enumeration date
10/17/2016
Last updated
04/16/2025
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