Provider Demographics
NPI:1497098263
Name:WALDON, SUSAN NYEESHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:NYEESHA
Last Name:WALDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 CLARKWOOD PKWY APT 413
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4836
Mailing Address - Country:US
Mailing Address - Phone:216-339-6188
Mailing Address - Fax:
Practice Address - Street 1:4400 CLARKWOOD PKWY APT 413
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4836
Practice Address - Country:US
Practice Address - Phone:216-339-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139136164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse