Healthcare Provider Details

I. General information

NPI: 1679755441
Provider Name (Legal Business Name): SUSAN M BOYER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 ECHO HILL RD
MALTA OH
43758-9704
US

IV. Provider business mailing address

4275 ECHO HILL RD
MALTA OH
43758-9704
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-6563
  • Fax:
Mailing address:
  • Phone: 740-962-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN078330
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: