Provider Demographics
NPI:1750768776
Name:PELLAR, SUZANNE (RN, CNS-BC)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:
Last Name:PELLAR
Suffix:
Gender:F
Credentials:RN, CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-942-1910
Mailing Address - Fax:219-942-3829
Practice Address - Street 1:1507 WABASH ST
Practice Address - Street 2:SUITE 400D
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4300
Practice Address - Country:US
Practice Address - Phone:219-861-8828
Practice Address - Fax:219-861-8827
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2006010894364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health