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General NPI Number Information
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NPI Number | 1902221468
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Entity Type | Individual
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Provider Name | SUSAN DISABATINO
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 418 W MARTINDALE RD
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City | UNION
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State | OH
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Zip | 45322-3005
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Country | US
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Telephone | 937-832-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 OLD SALEM RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2681
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Country | US
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Telephone | 937-832-5000
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Fax |
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | RN212157
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License Number State | OH
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