Provider Demographics
NPI:1619568292
Name:NIEHAUS, SUSAN JANE
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JANE
Last Name:NIEHAUS
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 1:2189 MORROW TRAIL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-8076
Mailing Address - Country:US
Mailing Address - Phone:513-868-1824
Mailing Address - Fax:
Practice Address - Street 1:2189 MORROW TRAIL
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-8076
Practice Address - Country:US
Practice Address - Phone:513-868-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906745Medicaid