Healthcare Provider Details

I. General information

NPI: 1538577515
Provider Name (Legal Business Name): SUZANN CRUMP STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 TREMAINE RD
COLUMBUS OH
43232-6024
US

IV. Provider business mailing address

3431 TREMAINE RD
COLUMBUS OH
43232
US

V. Phone/Fax

Practice location:
  • Phone: 614-321-6796
  • Fax: 614-321-6796
Mailing address:
  • Phone: 614-321-6796
  • Fax: 614-321-6796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number501123850606
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: