Provider Demographics
NPI:1942897731
Name:DETTY, SUZANNE E I
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:DETTY
Suffix:I
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 1:2614 LICK RUN RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9453
Mailing Address - Country:US
Mailing Address - Phone:740-710-2327
Mailing Address - Fax:
Practice Address - Street 1:2614 LICK RUN RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9453
Practice Address - Country:US
Practice Address - Phone:740-710-2327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4064300376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker