Inthavong, Susada

Inthavong, Susada is an individual health care provider with primary practice located at 1504 Sullivan Ave , South Windsor CT 06074-2711. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Inthavong, Susada can be contacted via phone (860) 644-1523.

Contact Information

Primary practice address
1504 Sullivan Ave South Windsor CT 06074-2711
Phone: (860) 644-1523
Fax: (860) 648-9468
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 003968 Connecticut

Profile Details

NPI number 1275770398
LBN Legal business name Inthavong, Susada
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2009
Last updated Jan 12th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275770398 NPPES
Connecticut Other 003968 STATE LICENSE

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