Individual
SUSAN BROWN STAVINOHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
313 E 12TH ST, STE 104, AUSTIN, TX 78701-1954
(512) 324-7000
Mailing address
313 E 12TH ST, AUSTIN, TX 78701-1954
(512) 324-7000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01664
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182810503
—
TX
01
—
819N07
BCBS
TX
Enumeration date
01/17/2007
Last updated
12/13/2012
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