Provider Demographics
NPI:1265689020
Name:TROMBLEY, SUSAN LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEE
Last Name:TROMBLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:LEE
Other - Last Name:ASHLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8 MAPLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-9739
Mailing Address - Country:US
Mailing Address - Phone:518-561-5186
Mailing Address - Fax:518-561-5186
Practice Address - Street 1:8 MAPLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-9739
Practice Address - Country:US
Practice Address - Phone:518-561-5186
Practice Address - Fax:518-561-5186
Is Sole Proprietor?:No
Enumeration Date:2008-08-24
Last Update Date:2008-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332411-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340207Medicaid