Provider Demographics
NPI:1376748442
Name:NAUGLE, SUSIE A (LPN)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:A
Last Name:NAUGLE
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 1:14221 N 51ST AVENUE
Mailing Address - Street 2:#2165
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-863-7902
Mailing Address - Fax:
Practice Address - Street 1:4650 W SWEETWATER
Practice Address - Street 2:WASHINGTON ELEMENTARY SCHOOL DISTRICT SHAW BUTLE ELEMEN
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304
Practice Address - Country:US
Practice Address - Phone:602-347-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP037763164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse