Provider Demographics
NPI:1942583984
Name:COUNCILMAN, SUE
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:
Last Name:COUNCILMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HOT SPRINGS RD STE 5E
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1601
Mailing Address - Country:US
Mailing Address - Phone:775-884-9024
Mailing Address - Fax:775-884-9025
Practice Address - Street 1:101 HOT SPRINGS RD STE 5E
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1601
Practice Address - Country:US
Practice Address - Phone:775-884-9024
Practice Address - Fax:775-884-9025
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies