Provider Demographics
NPI:1730306606
Name:TSUPER, VASILY N (RN)
Entity Type:Individual
Prefix:
First Name:VASILY
Middle Name:N
Last Name:TSUPER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 TOLLIS PKWY
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1809
Mailing Address - Country:US
Mailing Address - Phone:444-237-5224
Mailing Address - Fax:
Practice Address - Street 1:573 TOLLIS PKWY
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1809
Practice Address - Country:US
Practice Address - Phone:444-237-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH298587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse