Provider Demographics
NPI:1225541279
Name:NEELY, SUSANNA (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNA
Middle Name:
Last Name:NEELY
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:SUSANNA
Other - Middle Name:
Other - Last Name:MARUNENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:8034 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3205
Mailing Address - Country:US
Mailing Address - Phone:423-650-9901
Mailing Address - Fax:
Practice Address - Street 1:8034 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3205
Practice Address - Country:US
Practice Address - Phone:423-894-3836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily