Healthcare Provider Details

I. General information

NPI: 1336955905
Provider Name (Legal Business Name): SUZETTE C BASSETT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 AL HIGHWAY 157
CULLMAN AL
35058-0609
US

IV. Provider business mailing address

4261 COUNTY ROAD 1635
CULLMAN AL
35058-7417
US

V. Phone/Fax

Practice location:
  • Phone: 256-737-2222
  • Fax:
Mailing address:
  • Phone: 205-542-1596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1-082571
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: