Provider Demographics
NPI:1518099290
Name:ESQUIVIAS, SUSAN B
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:ESQUIVIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 HIGHWAY 54 W
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38012-6617
Mailing Address - Country:US
Mailing Address - Phone:731-772-9066
Mailing Address - Fax:
Practice Address - Street 1:950 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38012-2647
Practice Address - Country:US
Practice Address - Phone:731-772-0463
Practice Address - Fax:731-772-3377
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN070436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse