Provider Demographics
NPI:1184045064
Name:FAULKNER, SUSAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3343
Mailing Address - Country:US
Mailing Address - Phone:216-401-4745
Mailing Address - Fax:
Practice Address - Street 1:1051 E 98TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3343
Practice Address - Country:US
Practice Address - Phone:216-401-4745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN130531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse