Provider Demographics
NPI:1669511440
Name:FARMER, SUSAN E (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:FARMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11395 STATE ROUTE 104
Mailing Address - Street 2:LOT 32
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8014
Mailing Address - Country:US
Mailing Address - Phone:740-259-9515
Mailing Address - Fax:
Practice Address - Street 1:11395 STATE ROUTE 104
Practice Address - Street 2:LOT 32
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8014
Practice Address - Country:US
Practice Address - Phone:740-259-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN268048163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2228011Medicare UPIN