Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN205834 | GA |
NPI | 1003190448 |
---|---|
Provider Name | Brittany Kathryn Suchanek |
First Address | Atlanta, GA 30342-1605 |
Second Address | Atlanta, GA 30342-1605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2011 |
Last Update Date | 04/10/2011 |