Provider Demographics
NPI:1184231870
Name:EVERETT, SUZANNE C
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:EVERETT
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 1:6305 E WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9584
Mailing Address - Country:US
Mailing Address - Phone:419-825-5789
Mailing Address - Fax:
Practice Address - Street 1:6305 E WINDING WAY
Practice Address - Street 2:
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-9584
Practice Address - Country:US
Practice Address - Phone:419-825-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle