Healthcare Provider Details

I. General information

NPI: 1083306302
Provider Name (Legal Business Name): SUSAN HOUCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 TIMBERWOOD LN
SPRINGBORO OH
45066-9794
US

IV. Provider business mailing address

25 TIMBERWOOD LN
SPRINGBORO OH
45066-9794
US

V. Phone/Fax

Practice location:
  • Phone: 740-244-2296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: