Provider Demographics
NPI:1346561545
Name:CHEATWOOD, SUSAN DIANNE (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANNE
Last Name:CHEATWOOD
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 1:713 OAK ST
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4766
Mailing Address - Country:US
Mailing Address - Phone:256-591-5873
Mailing Address - Fax:
Practice Address - Street 1:1701 PELHAM RD S STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AL
Practice Address - Zip Code:36265-3372
Practice Address - Country:US
Practice Address - Phone:256-782-4256
Practice Address - Fax:256-782-4242
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2039828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse