Provider Demographics
NPI:1811061971
Name:ANDERSON, SUSAN M (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1665 MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1402
Mailing Address - Country:US
Mailing Address - Phone:239-513-7400
Mailing Address - Fax:239-513-7435
Practice Address - Street 1:1665 MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1402
Practice Address - Country:US
Practice Address - Phone:239-513-7400
Practice Address - Fax:239-513-7435
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL012304372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider