Healthcare Provider Details

I. General information

NPI: 1487913422
Provider Name (Legal Business Name): BRUCE A SUCHLAND CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W RUSSELL RD
SIDNEY OH
45365-9063
US

IV. Provider business mailing address

804 W RUSSELL RD
SIDNEY OH
45365-9063
US

V. Phone/Fax

Practice location:
  • Phone: 937-557-5657
  • Fax: 513-230-2024
Mailing address:
  • Phone: 937-557-5657
  • Fax: 513-230-2024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.13320-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: