Provider Demographics
NPI:1790041978
Name:CANTLEY, SUZANNE ALLISON (CRNP, CDE)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ALLISON
Last Name:CANTLEY
Suffix:
Gender:F
Credentials:CRNP, CDE
Other - Prefix:
Other - First Name:MELANIE SUZANNE
Other - Middle Name:ALLISON
Other - Last Name:CANTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST STE 112
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2524
Practice Address - Country:US
Practice Address - Phone:205-749-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-062554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL150139Medicaid