Provider Demographics
NPI:1548540917
Name:BOHANON, SUSAN L (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:BOHANON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 GLADE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-4510
Mailing Address - Country:US
Mailing Address - Phone:901-465-9373
Mailing Address - Fax:
Practice Address - Street 1:90 YUM YUM RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-4541
Practice Address - Country:US
Practice Address - Phone:901-465-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000069158163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health