Provider Demographics
NPI:1013631332
Name:ONEAL, SUZANNE M (LPN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:ONEAL
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 1:4903 INDIANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3513
Mailing Address - Country:US
Mailing Address - Phone:315-525-5358
Mailing Address - Fax:
Practice Address - Street 1:4903 INDIANTOWN RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476-3513
Practice Address - Country:US
Practice Address - Phone:315-525-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235667-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse