Provider Demographics
NPI:1972940849
Name:LUECK, SUSAN S (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:LUECK
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 1:198 OTTS SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3343
Mailing Address - Country:US
Mailing Address - Phone:864-576-3500
Mailing Address - Fax:864-595-2428
Practice Address - Street 1:198 OTTS SHOALS RD
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3343
Practice Address - Country:US
Practice Address - Phone:864-576-3500
Practice Address - Fax:864-595-2428
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC65298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse