Provider Demographics
NPI:1093302267
Name:PARISH, SUSAN DARLENE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DARLENE
Last Name:PARISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 SUSAN FLEEK RD
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6866
Mailing Address - Country:US
Mailing Address - Phone:304-790-2565
Mailing Address - Fax:304-788-6363
Practice Address - Street 1:846 SUSAN FLEEK RD
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6866
Practice Address - Country:US
Practice Address - Phone:304-790-2565
Practice Address - Fax:304-788-6363
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant