Provider Demographics
NPI:1003050857
Name:IONNO, SUSAN M (RN,BSN,CRNFA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:IONNO
Suffix:
Gender:F
Credentials:RN,BSN,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SCHOONER LANDING RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3133
Mailing Address - Country:US
Mailing Address - Phone:609-412-3367
Mailing Address - Fax:
Practice Address - Street 1:1172 ROUTE 72
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050
Practice Address - Country:US
Practice Address - Phone:609-412-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO10479400163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant