Provider Demographics
NPI:1306809959
Name:PRIDGEN, SUSAN YVONNE (ATC-L)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:YVONNE
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 AMBER LANTERN ST
Mailing Address - Street 2:APT 302
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-4580
Mailing Address - Country:US
Mailing Address - Phone:919-247-1213
Mailing Address - Fax:
Practice Address - Street 1:8409 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1004
Practice Address - Country:US
Practice Address - Phone:919-870-4273
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist