Healthcare Provider Details

I. General information

NPI: 1154675817
Provider Name (Legal Business Name): SUSAN JANE TRIM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 COMMERCE DR
PERRYSBURG OH
43551-5261
US

IV. Provider business mailing address

955 COMMERCE DR
PERRYSBURG OH
43551-5261
US

V. Phone/Fax

Practice location:
  • Phone: 419-874-8053
  • Fax: 419-874-8053
Mailing address:
  • Phone: 419-874-8053
  • Fax: 419-874-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: