Provider Demographics
NPI:1124397229
Name:NUGENT, SUZETTE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:MARIE
Last Name:NUGENT
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 1:375 BAKER ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-7551
Mailing Address - Country:US
Mailing Address - Phone:716-483-4225
Mailing Address - Fax:716-483-4417
Practice Address - Street 1:108 WHITEHILL AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-7928
Practice Address - Country:US
Practice Address - Phone:716-708-5900
Practice Address - Fax:716-483-4417
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY413539163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse