Provider Demographics
NPI:1164793634
Name:CHABON, SUZANNE LEE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEE
Last Name:CHABON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MANSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2485
Mailing Address - Country:US
Mailing Address - Phone:336-478-8648
Mailing Address - Fax:
Practice Address - Street 1:1704 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7905
Practice Address - Country:US
Practice Address - Phone:336-373-0678
Practice Address - Fax:336-275-3127
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200483363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily