Provider Demographics
NPI:1679614432
Name:GUYTON, SUSAN M
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GUYTON
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:PO BOX 35
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:MELROSE
Mailing Address - State:OH
Mailing Address - Zip Code:45861-0035
Mailing Address - Country:US
Mailing Address - Phone:419-594-3707
Mailing Address - Fax:
Practice Address - Street 1:404 PERRY STREET BOX 35
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:OH
Practice Address - Zip Code:45861-0035
Practice Address - Country:US
Practice Address - Phone:419-594-3707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2659994Medicaid