Healthcare Provider Details

I. General information

NPI: 1518099290
Provider Name (Legal Business Name): MRS. SUSAN B ESQUIVIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E MAIN ST
BROWNSVILLE TN
38012-2647
US

IV. Provider business mailing address

2691 HIGHWAY 54 W
BROWNSVILLE TN
38012-6617
US

V. Phone/Fax

Practice location:
  • Phone: 731-772-0463
  • Fax: 731-772-3377
Mailing address:
  • Phone: 731-772-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number070436
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: