Provider Demographics
NPI:1376932772
Name:CHENAULT, SUSSIE X (MSN/ED-RN)
Entity Type:Individual
Prefix:
First Name:SUSSIE
Middle Name:
Last Name:CHENAULT
Suffix:X
Gender:F
Credentials:MSN/ED-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25941 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-9309
Mailing Address - Country:US
Mailing Address - Phone:313-769-6432
Mailing Address - Fax:
Practice Address - Street 1:25941 TWIN OAK DRIVE
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-769-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470423360163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator