Provider Demographics
NPI:1083314595
Name:MYERS, SUSANNAH MARIE (RN)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:MARIE
Last Name:MYERS
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 1:4109 MEADOW TRACE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7588
Mailing Address - Country:US
Mailing Address - Phone:802-355-0368
Mailing Address - Fax:
Practice Address - Street 1:352 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3406
Practice Address - Country:US
Practice Address - Phone:864-372-3045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC269745163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse