Healthcare Provider Details

I. General information

NPI: 1225554983
Provider Name (Legal Business Name): SUZANNE BANNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009
US

IV. Provider business mailing address

4670 CREW HOOD RD
GIRARD OH
44420-1319
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-3626
  • Fax:
Mailing address:
  • Phone: 330-398-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN700821
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: