Provider Demographics
NPI:1356711774
Name:OBAS, SUZE MARGUERITE (LPN)
Entity type:Individual
Prefix:
First Name:SUZE
Middle Name:MARGUERITE
Last Name:OBAS
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 1:322 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3368
Mailing Address - Country:US
Mailing Address - Phone:347-217-0764
Mailing Address - Fax:
Practice Address - Street 1:16937 144TH RD
Practice Address - Street 2:N/A
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-5929
Practice Address - Country:US
Practice Address - Phone:718-978-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288999-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse