Provider Demographics
NPI:1366684789
Name:WHITMAN, SUSAN A (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:WHITMAN
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 1:2808 STAGECOACH CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-7354
Mailing Address - Country:US
Mailing Address - Phone:308-382-7326
Mailing Address - Fax:
Practice Address - Street 1:2808 STAGECOACH CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7354
Practice Address - Country:US
Practice Address - Phone:308-382-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE27354163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse