Provider Demographics
NPI:1770917932
Name:SUICO, MARGIE PAREJA (RN)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:PAREJA
Last Name:SUICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARGIE
Other - Middle Name:MARIQUIT
Other - Last Name:PAREJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:6261 CARSON DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8740
Mailing Address - Country:US
Mailing Address - Phone:662-893-8643
Mailing Address - Fax:
Practice Address - Street 1:6261 CARSON DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8740
Practice Address - Country:US
Practice Address - Phone:662-893-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR815303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse