Healthcare Provider Details

I. General information

NPI: 1255245288
Provider Name (Legal Business Name): SUSAN ANN MARIE FARMER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 LEON RD
ANDOVER OH
44003-9629
US

IV. Provider business mailing address

5319 LEON RD
ANDOVER OH
44003-9629
US

V. Phone/Fax

Practice location:
  • Phone: 440-969-4134
  • Fax:
Mailing address:
  • Phone: 440-969-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.183034.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: