Provider Demographics
NPI:1326338831
Name:DAVENPORT, SUZAN REBECCA (RN)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:REBECCA
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5387 MARINERS COVE DRIVE
Mailing Address - Street 2:#313
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704
Mailing Address - Country:US
Mailing Address - Phone:608-219-7168
Mailing Address - Fax:
Practice Address - Street 1:5387 MARINERS COVE DR
Practice Address - Street 2:#313
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7614
Practice Address - Country:US
Practice Address - Phone:608-219-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131515-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse