Provider Demographics
NPI:1992000939
Name:ABDULLAH, SUSAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:GAUTREAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:902 HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-7906
Mailing Address - Country:US
Mailing Address - Phone:601-876-0204
Mailing Address - Fax:601-213-4880
Practice Address - Street 1:902 HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-7906
Practice Address - Country:US
Practice Address - Phone:601-876-0204
Practice Address - Fax:601-213-4880
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse