Provider Demographics
NPI:1922442276
Name:CHAVIS, SUSAN (RN, MSN, NCSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:RN, MSN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 LONE STAR ROAD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:SC
Mailing Address - Zip Code:29030
Mailing Address - Country:US
Mailing Address - Phone:803-826-6789
Mailing Address - Fax:
Practice Address - Street 1:125 HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:SC
Practice Address - Zip Code:29135-1127
Practice Address - Country:US
Practice Address - Phone:803-655-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42970163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool