Provider Demographics
NPI:1891053013
Name:BAULENI, SUSAN NCHIMUNYA (LPN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NCHIMUNYA
Last Name:BAULENI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 DARROW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6081
Mailing Address - Country:US
Mailing Address - Phone:216-482-6672
Mailing Address - Fax:
Practice Address - Street 1:2093 DARROW LAKE DR
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6081
Practice Address - Country:US
Practice Address - Phone:216-482-6672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 148406164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse