Provider Demographics
NPI:1811232275
Name:CHESEBROUGH-PRUITT, SUZANN (RN)
Entity Type:Individual
Prefix:
First Name:SUZANN
Middle Name:
Last Name:CHESEBROUGH-PRUITT
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 1:1349 W HORIZON RIDGE PKWY
Mailing Address - Street 2:#921
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2464
Mailing Address - Country:US
Mailing Address - Phone:702-606-5635
Mailing Address - Fax:
Practice Address - Street 1:520 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5578
Practice Address - Country:US
Practice Address - Phone:702-759-0889
Practice Address - Fax:702-558-3127
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378571163WC1500X
NVRN25706163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN25706OtherRN LICENSE
CA378571OtherR.N. LICENSE