Provider Demographics
NPI:1821304932
Name:OSTERHOUDT, SUZANNE RENEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RENEE
Last Name:OSTERHOUDT
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:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:LITTLE YORK
Mailing Address - State:NY
Mailing Address - Zip Code:13087-0028
Mailing Address - Country:US
Mailing Address - Phone:607-749-7188
Mailing Address - Fax:
Practice Address - Street 1:60 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2795
Practice Address - Country:US
Practice Address - Phone:607-753-5203
Practice Address - Fax:607-758-5542
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424879163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health