Provider Demographics
NPI:1649449372
Name:BASKIN, SUSIE Q (MSN)
Entity type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:Q
Last Name:BASKIN
Suffix:
Gender:F
Credentials:MSN
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Other - Credentials:
Mailing Address - Street 1:50 N. DUNLAP STREET
Mailing Address - Street 2:LEBONHEUR CHILDREN'S MEDICAL CENTER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103
Mailing Address - Country:US
Mailing Address - Phone:901-287-4825
Mailing Address - Fax:901-287-4845
Practice Address - Street 1:66 N. PAULINE STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105
Practice Address - Country:US
Practice Address - Phone:901-448-6936
Practice Address - Fax:901-448-7692
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2020-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN6056363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02475341Medicaid