Provider Demographics
NPI:1689846222
Name:GAKURU, SUSAN NYARUAI (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NYARUAI
Last Name:GAKURU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 PELHAM DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4308
Mailing Address - Country:US
Mailing Address - Phone:440-317-2132
Mailing Address - Fax:
Practice Address - Street 1:6603 SUNDERLAND DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-4523
Practice Address - Country:US
Practice Address - Phone:440-317-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN125122164W00000X
OHRN498858163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse