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NPI Code Detail

MEDICARE: MRS. SUSAN AULT LPN

MEDICARE: MRS. SUSAN AULT LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse105590OH

General Provider Information

NPI Number : 1013442706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN AULT LPN
Provider Business Mailing Address
First Line : 1 HALLORAN PARK LN
Second Line :
City : SAINT CLAIRSVILLE
State : OH
Zip : 43950-1367
Country : US
Telephone Number : 740-296-5743
Fax Number : 740-296-5952
Provider Business Practice Location Address
First Line : 1 HALLORAN PARK LN
Second Line :
City : SAINT CLAIRSVILLE
State : OH
Zip : 43950-1367
Country : US
Telephone Number : 740-296-5743
Fax Number : 740-296-5952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 05/01/2017

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