Provider Demographics
NPI:1639448665
Name:SUDING, JOAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:
Last Name:SUDING
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 1:12163 SAINT PETERS RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-9136
Mailing Address - Country:US
Mailing Address - Phone:812-623-3584
Mailing Address - Fax:
Practice Address - Street 1:12163 ST PETERS ROAD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012
Practice Address - Country:US
Practice Address - Phone:812-623-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN315019163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator