Provider Demographics
NPI:1497171623
Name:TREMAINE, SUSAN P (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:P
Last Name:TREMAINE
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 1:8616 COLUMBIA AVE.
Mailing Address - Street 2:SCHOOL TOWN OF MUNSTER
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-836-9111
Mailing Address - Fax:219-836-3215
Practice Address - Street 1:8718 WHITE OAK AVE
Practice Address - Street 2:ELLIOTT ELEMENTARY SCHOOL
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-838-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28066902A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse