Provider Demographics
NPI:1629613732
Name:SUGG, CLARISSA (CNP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:SUGG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CLARISSA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:3561 TRUMAN RD LOT 278
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9569
Mailing Address - Country:US
Mailing Address - Phone:419-280-7739
Mailing Address - Fax:
Practice Address - Street 1:1180 N MAIN ST STE 5
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4932
Practice Address - Country:US
Practice Address - Phone:419-315-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine