Provider Demographics
NPI:1053587303
Name:GARRETT, SUSAN K (LPN)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:K
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:K
Other - Last Name:KEHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:9692 SUMMIT STREET RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-8971
Mailing Address - Country:US
Mailing Address - Phone:585-219-7224
Mailing Address - Fax:
Practice Address - Street 1:9692 SUMMIT STREET RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-8971
Practice Address - Country:US
Practice Address - Phone:585-219-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231882-1164W00000X
NY231882164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02858813Medicaid