Provider Demographics
NPI:1912448408
Name:MITCHUALMACAULEY, SUZANE
Entity Type:Individual
Prefix:
First Name:SUZANE
Middle Name:
Last Name:MITCHUALMACAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 LLEWELYN AVE
Mailing Address - Street 2:UPLIFT FAMILY SERVICES
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-876-4256
Mailing Address - Fax:
Practice Address - Street 1:251 LLEWELYN AVE
Practice Address - Street 2:UPLIFT FAMILY SERVICES
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-876-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN253939164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse