Basic Information
| Provider Information | |||||||||
| NPI: | 1043881857 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEELY | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | RENE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 793 | ||||||||
| Address2: | |||||||||
| City: | HARDY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725420793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708477125 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30 HONDO CIR | ||||||||
| Address2: | |||||||||
| City: | CHEROKEE VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725292315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4174131460 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2021 | ||||||||
| LastUpdateDate: | 07/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WI0500X | R087680 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Infusion Therapy |
No ID Information.