Provider Demographics
NPI:1336471952
Name:JENNINGS, SUSAN ROSS (BS RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ROSS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:BS RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WALLACE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-7222
Mailing Address - Country:US
Mailing Address - Phone:845-735-4675
Mailing Address - Fax:
Practice Address - Street 1:23 WALLACE DR
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-7222
Practice Address - Country:US
Practice Address - Phone:845-735-4675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY570275-1163W00000X
NJNR80163163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse