Provider Demographics
NPI:1407005622
Name:TULLON, SUZANNE A (RN)
Entity Type:Individual
Prefix:MISS
First Name:SUZANNE
Middle Name:A
Last Name:TULLON
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 1:15 ETHEL LN
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1029
Mailing Address - Country:US
Mailing Address - Phone:631-872-8695
Mailing Address - Fax:
Practice Address - Street 1:15 ETHEL LN
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1029
Practice Address - Country:US
Practice Address - Phone:631-872-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22527930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse