Provider Demographics
NPI:1689208696
Name:QUAIL, SUSAN ANN (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:QUAIL
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GOLDEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-8015
Mailing Address - Country:US
Mailing Address - Phone:712-260-8548
Mailing Address - Fax:
Practice Address - Street 1:150 GOLDEN OAK DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8015
Practice Address - Country:US
Practice Address - Phone:712-260-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC283952163W00000X
IA087592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty