Provider Demographics
NPI:1083648083
Name:SLONE, SUSAN JEANINE (RN MSN CNS)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEANINE
Last Name:SLONE
Suffix:
Gender:F
Credentials:RN MSN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122
Mailing Address - Country:US
Mailing Address - Phone:317-718-0605
Mailing Address - Fax:317-718-0720
Practice Address - Street 1:258 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-718-0605
Practice Address - Fax:317-718-0720
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000118163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000377490OtherANTHEM BCBS
000000377490OtherANTHEM BCBS
P98632Medicare UPIN