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General NPI Number Information
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NPI Number | 1770854341
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Entity Type | Individual
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Provider Name | SUSAN MARY ZIDERS CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 8401 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-6725
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Country | US
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Telephone | 330-729-7633
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Fax | 330-729-7656
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Provider Business Mailing Address
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Address Line | 1 PERKINS SQ
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City | AKRON
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State | OH
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Zip | 44308-1063
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Country | US
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Telephone | 330-729-7633
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Fax | 330-729-7656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | COA.13130-NP
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License Number State | OH
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