Provider Demographics
NPI:1740679323
Name:MCLAIN, SUSIE S (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:S
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SUSIE
Other - Middle Name:S
Other - Last Name:BLAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10192 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9164
Mailing Address - Country:US
Mailing Address - Phone:720-320-4006
Mailing Address - Fax:
Practice Address - Street 1:10192 RIVERSTONE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9164
Practice Address - Country:US
Practice Address - Phone:720-320-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0184119282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren