Provider Demographics
NPI:1144940586
Name:SU, PEI-TZU ANGELA (RN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:PEI-TZU
Middle Name:ANGELA
Last Name:SU
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6529 MIRAMAR CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3125 S SCATTERFIELD RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-1802
Practice Address - Country:US
Practice Address - Phone:765-298-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-06-20
Deactivation Date:2023-07-17
Deactivation Code:
Reactivation Date:2023-08-04
Provider Licenses
StateLicense IDTaxonomies
IN28254309A163WP0808X
IN71014113A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health