Healthcare Provider Details

I. General information

NPI: 1700246725
Provider Name (Legal Business Name): SUSAN F GARRETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

IV. Provider business mailing address

1307 KERCHER ST
MIAMISBURG OH
45342-1905
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-7747
  • Fax:
Mailing address:
  • Phone: 937-859-7695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18295-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: