Provider Demographics
NPI:1891839387
Name:SANCHEZ, SUSAN EMILLIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:EMILLIA
Last Name:SANCHEZ
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 1:515 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1231
Mailing Address - Country:US
Mailing Address - Phone:307-637-8372
Mailing Address - Fax:
Practice Address - Street 1:604 E 25TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3133
Practice Address - Country:US
Practice Address - Phone:307-637-3953
Practice Address - Fax:307-638-6805
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse