Provider Demographics
NPI:1427114396
Name:ELDRED, SUZETTE L (WHCNP)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:L
Last Name:ELDRED
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9202 ELAM RD
Practice Address - Street 2:SOUTHEAST DALLAS WOMEN'S HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4151
Practice Address - Country:US
Practice Address - Phone:214-266-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX619003363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061245902Medicaid
TX061246711Medicaid
TX061246718Medicaid
TX061246716Medicaid
TX061246715Medicaid
TX061246710Medicaid
TX061246712Medicaid
TX061246713Medicaid
TX061246714Medicaid
TX061246708Medicaid
TX061246717Medicaid
TX8Y3787OtherBLUE CROSS BLUE SHIELD
TX061246709Medicaid