Provider Demographics
NPI:1639484496
Name:LUGAR, SUSAN ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:LUGAR
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 1:3303 W ILLINOIS AVE
Mailing Address - Street 2:SPACE 22
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-6213
Mailing Address - Country:US
Mailing Address - Phone:432-681-7613
Mailing Address - Fax:
Practice Address - Street 1:3303 W ILLINOIS AVE
Practice Address - Street 2:SPACE 22
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6213
Practice Address - Country:US
Practice Address - Phone:432-681-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX739645163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health