Provider Demographics
NPI:1033677323
Name:MCNEELY, SUSANA I (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSANA
Middle Name:I
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SILVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-5010
Mailing Address - Country:US
Mailing Address - Phone:831-345-0468
Mailing Address - Fax:
Practice Address - Street 1:195 AVIATION WAY
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2053
Practice Address - Country:US
Practice Address - Phone:831-728-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95156652163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse