Individual
DR. SUSAN J VAN FOSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN, BC, PMHNP,
Contact information
Practice address
616 W RUSSELL PL, SAN ANTONIO, TX 78212-3658
(800) 257-8715
(800) 819-1655
Mailing address
1105 CLIFF SWALLOW DR, GRANBURY, TX 76048-2651
(817) 579-6757
(800) 819-1655
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
232874
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118282601
—
TX
05
—
118282602
—
TX
05
—
118282603
—
TX
01
—
118282605
INDIVIDUAL
TX
01
—
500012787
RAILROAD
TX
01
—
87N290
BLUE CROSS BLUE SHIELD
TX
01
—
8N3327
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/03/2006
Last updated
02/19/2010
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