Healthcare Provider Details

I. General information

NPI: 1245353036
Provider Name (Legal Business Name): SUSAN H RYCKMAN RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2004
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4770
  • Fax: 513-636-3847
Mailing address:
  • Phone: 513-636-2039
  • Fax: 866-851-6567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.039366-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: