Provider Demographics
NPI:1235406257
Name:TRAVIS, SUEHAIL (LPN)
Entity Type:Individual
Prefix:MS
First Name:SUEHAIL
Middle Name:
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 W 127TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4501
Mailing Address - Country:US
Mailing Address - Phone:216-882-2058
Mailing Address - Fax:
Practice Address - Street 1:3614 W 127TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4501
Practice Address - Country:US
Practice Address - Phone:216-882-2058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-147158164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse