Provider Demographics
NPI:1740645142
Name:HAGAR, SUZANNE (RN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HAGAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6022 BINNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SCOOBA
Mailing Address - State:MS
Mailing Address - Zip Code:39358-7219
Mailing Address - Country:US
Mailing Address - Phone:615-476-5063
Mailing Address - Fax:
Practice Address - Street 1:6022 BINNSVILLE RD
Practice Address - Street 2:
Practice Address - City:SCOOBA
Practice Address - State:MS
Practice Address - Zip Code:39358-7219
Practice Address - Country:US
Practice Address - Phone:615-476-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN129714163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care