Provider Demographics
NPI:1790341709
Name:EVANS, SUZANNE MICHELLE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NELSON RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-6124
Mailing Address - Country:US
Mailing Address - Phone:607-785-1350
Mailing Address - Fax:
Practice Address - Street 1:600 S BENITA BLVD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2675
Practice Address - Country:US
Practice Address - Phone:607-757-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688997-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool