Provider Demographics
NPI:1710447727
Name:SAENZ, SUSSAN YVETTE (RN)
Entity Type:Individual
Prefix:
First Name:SUSSAN
Middle Name:YVETTE
Last Name:SAENZ
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 1:4104 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1250
Mailing Address - Country:US
Mailing Address - Phone:210-364-3103
Mailing Address - Fax:
Practice Address - Street 1:4104 IRIS AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1250
Practice Address - Country:US
Practice Address - Phone:210-364-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961048163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse