Provider Demographics
NPI:1306684121
Name:TEAGUE, SUZANNA EILEEN (APRN-CNM)
Entity type:Individual
Prefix:
First Name:SUZANNA
Middle Name:EILEEN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N PERKINS RD APT D27
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5767
Mailing Address - Country:US
Mailing Address - Phone:405-385-3581
Mailing Address - Fax:
Practice Address - Street 1:1400 N PERKINS RD APT D27
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5767
Practice Address - Country:US
Practice Address - Phone:405-385-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK218950367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife