Healthcare Provider Details

I. General information

NPI: 1104067917
Provider Name (Legal Business Name): SUSANNA MARIE KERR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 MALLARD CIR W
NEWARK OH
43055-9222
US

IV. Provider business mailing address

1538 MALLARD CIR W
NEWARK OH
43055-9222
US

V. Phone/Fax

Practice location:
  • Phone: 740-366-7497
  • Fax:
Mailing address:
  • Phone: 740-366-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.344275
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: