Provider Demographics
NPI:1952886780
Name:SKADAN, SUZANNE REH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:REH
Last Name:SKADAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8300
Mailing Address - Country:US
Mailing Address - Phone:559-730-7580
Mailing Address - Fax:
Practice Address - Street 1:5000 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8300
Practice Address - Country:US
Practice Address - Phone:559-730-7580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371092163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty