Provider Demographics
NPI:1346518909
Name:NORMAN, SUSAN (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:NORMAN
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-0130
Mailing Address - Country:US
Mailing Address - Phone:315-797-1115
Mailing Address - Fax:315-797-3883
Practice Address - Street 1:131 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2832
Practice Address - Country:US
Practice Address - Phone:315-797-1115
Practice Address - Fax:315-797-3883
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1086951164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse