Provider Demographics
NPI:1558019703
Name:CRONEMEYER, SUSAN ELAINE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:CRONEMEYER
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 1:2404 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1061
Mailing Address - Country:US
Mailing Address - Phone:580-465-3731
Mailing Address - Fax:
Practice Address - Street 1:2505 CROSSROADS DRIVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1061
Practice Address - Country:US
Practice Address - Phone:580-564-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator