Provider Demographics
NPI:1962690396
Name:RYAN, SUZANNE MARIE (LVN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:PO BOX 3725
Mailing Address - Street 2:
Mailing Address - City:HELENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:92342-3725
Mailing Address - Country:US
Mailing Address - Phone:760-553-4752
Mailing Address - Fax:
Practice Address - Street 1:17820 DUNKIRK ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-7301
Practice Address - Country:US
Practice Address - Phone:760-553-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN192442164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse