Provider Demographics
NPI:1699247817
Name:NG, SUE ELLEN
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:NG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ELLEN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2516 CAPARZO DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1613
Mailing Address - Country:US
Mailing Address - Phone:512-818-6748
Mailing Address - Fax:
Practice Address - Street 1:2516 CAPARZO DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1613
Practice Address - Country:US
Practice Address - Phone:512-818-6748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215789163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health