=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235280041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN JANINE SPIERS FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2007
-----------------------------------------------------
Last Update Date | 06/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9159 N COUNTY RD 25A PIQUA FAMILY PRACTICE INC
-----------------------------------------------------
City | PIQUA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-773-8221
-----------------------------------------------------
Fax | 937-773-5117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9159 N COUNTY RD 25A
-----------------------------------------------------
City | PIQUA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-773-8221
-----------------------------------------------------
Fax | 937-773-5117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | NP09038RN223748
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------