Healthcare Provider Details

I. General information

NPI: 1467891226
Provider Name (Legal Business Name): CARMEN SUE HUFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MILL STREET LOT 152
NORTH LEWISBURG OH
43060
US

IV. Provider business mailing address

701 MILL STREET LOT 152
NORTH LEWISBURG OH
43060
US

V. Phone/Fax

Practice location:
  • Phone: 614-377-3507
  • Fax:
Mailing address:
  • Phone: 614-377-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN390141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: