Healthcare Provider Details

I. General information

NPI: 1871890400
Provider Name (Legal Business Name): SUSAN RUTH LYTLE AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 ALCOA HWY SUITE G50
KNOXVILLE TN
37920-1527
US

IV. Provider business mailing address

1932 ALCOA HWY SUITE G50
KNOXVILLE TN
37920-1527
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-8154
  • Fax: 865-305-4769
Mailing address:
  • Phone: 865-305-8154
  • Fax: 865-305-4769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA0000001091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: