Provider Demographics
NPI:1972852465
Name:SPIVEY, SUE E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:E
Last Name:SPIVEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 S 61ST ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3403
Mailing Address - Country:US
Mailing Address - Phone:414-801-7378
Mailing Address - Fax:
Practice Address - Street 1:4465 S 61ST ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3403
Practice Address - Country:US
Practice Address - Phone:414-801-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26265031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse