Provider Demographics
NPI:1346616299
Name:REDD, SUSAN DIANE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:REDD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:238 IRVING TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14223-2319
Mailing Address - Country:US
Mailing Address - Phone:501-574-1978
Mailing Address - Fax:
Practice Address - Street 1:238 IRVING TER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14223-2319
Practice Address - Country:US
Practice Address - Phone:501-574-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691839-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse