Healthcare Provider Details

I. General information

NPI: 1215244223
Provider Name (Legal Business Name): SUSAN MACMILLAN RIOUX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE EDUCATIONAL SERVICES DEPT
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

736 IRVING AVE EDUCATIONAL SERVICES DEPT
SYRACUSE NY
13210-1687
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7801
  • Fax: 315-470-2764
Mailing address:
  • Phone: 315-470-7801
  • Fax: 315-470-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number276781-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: