Provider Demographics
NPI:1215244223
Name:RIOUX, SUSAN MACMILLAN (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MACMILLAN
Last Name:RIOUX
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 1:736 IRVING AVE
Mailing Address - Street 2:EDUCATIONAL SERVICES DEPT
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1687
Mailing Address - Country:US
Mailing Address - Phone:315-470-7801
Mailing Address - Fax:315-470-2764
Practice Address - Street 1:736 IRVING AVE
Practice Address - Street 2:EDUCATIONAL SERVICES DEPT
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1687
Practice Address - Country:US
Practice Address - Phone:315-470-7801
Practice Address - Fax:315-470-2764
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276781-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center