Provider Demographics
NPI:1801341086
Name:HATHCOCK, SUZETTE (RN)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:HATHCOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W TANNER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-4722
Mailing Address - Country:US
Mailing Address - Phone:480-984-3216
Mailing Address - Fax:480-380-0105
Practice Address - Street 1:2930 W TANNER RANCH RD
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-4722
Practice Address - Country:US
Practice Address - Phone:480-984-3216
Practice Address - Fax:480-380-0105
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN193592163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool