MEDICARE: SUSAN RECKER NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN.219272	OH

General Provider Information

NPI Number	:	1730637430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RECKER NP-C

Provider Business Mailing Address
First Line	:	5210 RENWYCK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5968
Country	:	US
Telephone Number	:	419-385-5751
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 RENWYCK DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-5968
Country	:	US
Telephone Number	:	419-385-5751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2016
Last Update Date	:	09/12/2016

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