Provider Demographics
NPI:1205030400
Name:LEGUIRE, SUSAN K (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:LEGUIRE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-960-4000
Mailing Address - Fax:440-960-4017
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:BEHAVIORAL HEALTH UNIT
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1611
Practice Address - Country:US
Practice Address - Phone:440-960-4000
Practice Address - Fax:440-960-4017
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09106363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3025372Medicaid
OH2821781Medicaid
OH9389631Medicare PIN
OH3025372Medicaid
OH2821781Medicaid