Healthcare Provider Details

I. General information

NPI: 1417507195
Provider Name (Legal Business Name): SUZANNE KAY HUFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 AVIATION DR
WEST LAFAYETTE IN
47906-3374
US

IV. Provider business mailing address

1650 AVIATION DR
WEST LAFAYETTE IN
47906-3374
US

V. Phone/Fax

Practice location:
  • Phone: 765-743-2337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number28092604A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: