Provider Demographics
NPI:1467061366
Name:HARRELL, SUSAN J (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:HARRELL
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 1:12521 PLEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-8301
Mailing Address - Country:US
Mailing Address - Phone:225-337-4669
Mailing Address - Fax:
Practice Address - Street 1:11300 HWY 1033
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7072
Practice Address - Country:US
Practice Address - Phone:225-337-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA078172163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool