Provider Demographics
NPI:1700228517
Name:NEWMAN, SUSAN DIANE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANE
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:310 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-6208
Mailing Address - Country:US
Mailing Address - Phone:209-620-4258
Mailing Address - Fax:
Practice Address - Street 1:310 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-6208
Practice Address - Country:US
Practice Address - Phone:209-620-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 192397164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse