Provider Demographics
NPI:1144055534
Name:BECKLEY, SUSAN TOYIN (LPN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:TOYIN
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SESAN
Other - Middle Name:OLUWATOYIN
Other - Last Name:ADENUGA-BALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:33 W FRANKLIN ST STE 213
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4832
Mailing Address - Country:US
Mailing Address - Phone:240-203-3312
Mailing Address - Fax:
Practice Address - Street 1:33 W FRANKLIN ST STE 213
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4832
Practice Address - Country:US
Practice Address - Phone:240-203-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06072800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse