Provider Demographics
NPI:1245656537
Name:HONNESS, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HONNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19390 PEEL DOCK RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13640-3166
Mailing Address - Country:US
Mailing Address - Phone:315-804-9799
Mailing Address - Fax:
Practice Address - Street 1:19390 PEEL DOCK RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY ISLAND
Practice Address - State:NY
Practice Address - Zip Code:13640-3166
Practice Address - Country:US
Practice Address - Phone:315-804-9799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2761581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse