Provider Demographics
NPI:1477859734
Name:ROYALTY, SUSAN RENEE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:ROYALTY
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 1:8777 PURDUE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3125
Mailing Address - Country:US
Mailing Address - Phone:812-344-2470
Mailing Address - Fax:317-755-4012
Practice Address - Street 1:8777 PURDUE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3125
Practice Address - Country:US
Practice Address - Phone:812-344-2470
Practice Address - Fax:317-755-4012
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168124A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse