Provider Demographics
NPI:1114158268
Name:ONEAL, MARY SUSANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUSANNE
Last Name:ONEAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:WHITEMAN
Other - Last Name:ONEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1380 KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7033
Mailing Address - Country:US
Mailing Address - Phone:909-793-0187
Mailing Address - Fax:
Practice Address - Street 1:1380 KNOLL RD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-7033
Practice Address - Country:US
Practice Address - Phone:909-793-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264430163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse