Provider Demographics
NPI:1679926208
Name:WINDHAM, SUZONNE M (NPF)
Entity Type:Individual
Prefix:
First Name:SUZONNE
Middle Name:M
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
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Mailing Address - Street 1:81767 DR CARREON BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5599
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:41865 BOARDWALK STE 103
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9031
Practice Address - Country:US
Practice Address - Phone:760-775-4181
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2023-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95004109363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care