Basic Information
| Provider Information | |||||||||
| NPI: | 1417463860 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADDESA | ||||||||
| FirstName: | SUSANNA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 ELM PL | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140862201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166814046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 STAHL RD | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166293400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WS0200X | 361652-1 | NY | Y | Nursing Service Providers | Registered Nurse | School |
No ID Information.