Healthcare Provider Details

I. General information

NPI: 1881943199
Provider Name (Legal Business Name): SUSAN BELLE UJVARI LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SAPPHIRE DRIVE
HUDSON OH
44236
US

IV. Provider business mailing address

1661 SAPPHIRE DRIVE
HUDSON OH
44236
US

V. Phone/Fax

Practice location:
  • Phone: 330-342-0956
  • Fax:
Mailing address:
  • Phone: 330-342-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.069561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: