Healthcare Provider Details

I. General information

NPI: 1750768776
Provider Name (Legal Business Name): SUZANNE PELLAR RN, CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 WABASH ST SUITE 400D
MICHIGAN CITY IN
46360-4300
US

IV. Provider business mailing address

7895 GRAND BLVD
HOBART IN
46342-6665
US

V. Phone/Fax

Practice location:
  • Phone: 219-861-8828
  • Fax: 219-861-8827
Mailing address:
  • Phone: 219-942-1910
  • Fax: 219-942-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2006010894
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: