Basic Information
| Provider Information | |||||||||
| NPI: | 1356397384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIONISIO | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5192 BAYOU BLVD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504845040 | ||||||||
| FaxNumber: | 8504755527 | ||||||||
| Practice Location | |||||||||
| Address1: | 5192 BAYOU BLVD | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325032102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504845040 | ||||||||
| FaxNumber: | 8504755527 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0400X | RN3053752 | FL | Y | Nursing Service Providers | Registered Nurse | Case Management |
ID Information
| ID | Type | State | Issuer | Description | RN3053752 | 01 | FL | NURSING LICENSE | OTHER |