Provider Demographics
NPI:1205025202
Name:XIONG, SUE KIACHIATONG (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:SUE
Middle Name:KIACHIATONG
Last Name:XIONG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3840
Mailing Address - Country:US
Mailing Address - Phone:651-793-7635
Mailing Address - Fax:
Practice Address - Street 1:1049 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3840
Practice Address - Country:US
Practice Address - Phone:651-793-7635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163W00000X163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR1557552OtherREGISTERED NURSE