Provider Demographics
NPI:1194582023
Name:EARLY, SUSANNE (RN)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:EARLY
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 1:2168 S SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2134
Mailing Address - Country:US
Mailing Address - Phone:925-407-7795
Mailing Address - Fax:
Practice Address - Street 1:2168 S SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-2134
Practice Address - Country:US
Practice Address - Phone:925-407-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0135634163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse