Provider Demographics
NPI:1528714961
Name:MONTENERY, SUSAN MARIE (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:MONTENERY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:LUOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 261954
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-6054
Mailing Address - Country:US
Mailing Address - Phone:843-349-6490
Mailing Address - Fax:
Practice Address - Street 1:111 CHANTICLEER DRIVE EAST
Practice Address - Street 2:SWAIN HALL 111
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29528-6054
Practice Address - Country:US
Practice Address - Phone:843-349-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC230521163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse