Most Relevant Information
Provider Data
| NPI Number: | 1003327875 |
| Provider Name: | SUSAN SOUTHERTON RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163WA2000X |
| Specialty: | Registered Nurse |
| License Number: | 420717-1 |
Most Important Dates
| Enumeration Date: | 10/19/2017 |
| Last Updated: | 10/19/2017 |
Provider Practice Location
256 SUNSET LAKE RD
LIBERTY
NY
127542847
Practice Location Phone/Fax
| Phone: | 8455132012 |
| Fax: | 8455132177 |
Provider Mailing Location
256 SUNSET LAKE RD
LIBERTY
NY
127542847
Provider Mailing Phone/Fax
| Phone: | 8455132012 |
| Fax: | 8455132177 |