Provider Demographics
NPI:1760675490
Name:SCHROERLUCKE, SUSAN KIM (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KIM
Last Name:SCHROERLUCKE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4003 KRESGE WAY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4652
Mailing Address - Country:US
Mailing Address - Phone:502-897-8163
Mailing Address - Fax:502-897-8052
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 115
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-8163
Practice Address - Fax:502-897-8052
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3270P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily