Provider Demographics
NPI:1184863565
Name:PRIDDY, SUSAN DEANN (RN, WCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEANN
Last Name:PRIDDY
Suffix:
Gender:F
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 OK HIGHWAY 78 S
Mailing Address - Street 2:
Mailing Address - City:MILBURN
Mailing Address - State:OK
Mailing Address - Zip Code:73450-0027
Mailing Address - Country:US
Mailing Address - Phone:580-257-0577
Mailing Address - Fax:580-443-5253
Practice Address - Street 1:10500 OK HIGHWAY 78 S
Practice Address - Street 2:
Practice Address - City:MILBURN
Practice Address - State:OK
Practice Address - Zip Code:73450-0027
Practice Address - Country:US
Practice Address - Phone:580-257-0577
Practice Address - Fax:580-443-5253
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069035163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care