Provider Demographics
NPI:1588874317
Name:DOWNING, SUZANNE E (LPN, PDN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:DOWNING
Suffix:
Gender:F
Credentials:LPN, PDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6247 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:LA VALLE
Mailing Address - State:WI
Mailing Address - Zip Code:53941-9305
Mailing Address - Country:US
Mailing Address - Phone:608-393-9882
Mailing Address - Fax:
Practice Address - Street 1:W6247 CLARK RD
Practice Address - Street 2:
Practice Address - City:LA VALLE
Practice Address - State:WI
Practice Address - Zip Code:53941-9305
Practice Address - Country:US
Practice Address - Phone:608-393-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35022300Medicaid