Provider Demographics
NPI:1104153873
Name:LOONEY, SUSAN RENEA (SA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEA
Last Name:LOONEY
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 RAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-1924
Mailing Address - Country:US
Mailing Address - Phone:256-302-2828
Mailing Address - Fax:256-891-7182
Practice Address - Street 1:300 RAY AVE
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-1924
Practice Address - Country:US
Practice Address - Phone:256-302-2828
Practice Address - Fax:256-891-7182
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09-299246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant