Provider Demographics
NPI:1467767053
Name:OXENDINE, SUZETTE RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:RENEE
Last Name:OXENDINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-272-1654
Practice Address - Street 1:307 E WARDELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7998
Practice Address - Country:US
Practice Address - Phone:910-521-2816
Practice Address - Fax:910-521-3583
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02405363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-02405OtherLICENSE