Provider Demographics
NPI:1518338656
Name:MATHEWS, SUSIE YVONNE (LPN)
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:YVONNE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:YVONNE
Other - Last Name:DRYWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:619 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4431
Mailing Address - Country:US
Mailing Address - Phone:918-687-1039
Mailing Address - Fax:918-683-9484
Practice Address - Street 1:619 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4431
Practice Address - Country:US
Practice Address - Phone:918-687-1039
Practice Address - Fax:918-683-9484
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0037251164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse