Provider Demographics
NPI:1518065044
Name:VON EHR, SUZAN V (APRN, BC)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:V
Last Name:VON EHR
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ALLISON CIR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3973
Mailing Address - Country:US
Mailing Address - Phone:219-707-9237
Mailing Address - Fax:219-961-8300
Practice Address - Street 1:2410 ALLISON CIR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3973
Practice Address - Country:US
Practice Address - Phone:219-707-9237
Practice Address - Fax:219-961-8300
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS56770Medicare UPIN