Provider Demographics
NPI:1437196185
Name:ASH, SUSAN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:ASH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HARBERT DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-5117
Mailing Address - Country:US
Mailing Address - Phone:937-208-7575
Mailing Address - Fax:937-208-7590
Practice Address - Street 1:1330 COSHOCTON RD
Practice Address - Street 2:1
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-9801
Practice Address - Fax:740-399-3182
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2485921Medicaid
OHNP15981Medicare PIN
OHNP15982Medicare PIN
OH2485921Medicaid