Provider Demographics
NPI:1942903505
Name:SLOAN, SUSAN RENEE (RN BSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:SLOAN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 ASH ST N
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9368
Mailing Address - Country:US
Mailing Address - Phone:509-429-8004
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1060
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WA
Practice Address - Zip Code:98813-1060
Practice Address - Country:US
Practice Address - Phone:509-686-2201
Practice Address - Fax:509-557-4922
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00153753163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool