Provider Demographics
NPI:1568761666
Name:RYAN, SUSIE M (LPN M - IV)
Entity Type:Individual
Prefix:MRS
First Name:SUSIE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPN M - IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 LICKING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8911
Mailing Address - Country:US
Mailing Address - Phone:740-763-0066
Mailing Address - Fax:
Practice Address - Street 1:1283 LICKING VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-8911
Practice Address - Country:US
Practice Address - Phone:740-763-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN066345385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child