Provider Demographics
NPI:1184692931
Name:MAHON, SUZANNE MARIE (RN DNSC AOCN APNG)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:MAHON
Suffix:
Gender:F
Credentials:RN DNSC AOCN APNG
Other - Prefix:MISS
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:DUBUQUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3655 VISTA AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2539
Mailing Address - Country:US
Mailing Address - Phone:314-977-4330
Mailing Address - Fax:314-773-1167
Practice Address - Street 1:3655 VISTA
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-577-6056
Practice Address - Fax:314-268-5108
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO93348163WX0200X, 364SX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
R61974Medicare UPIN