Provider Demographics
NPI:1952836033
Name:RUZVIDZO, JUNIOR SUSAN JR (LPN)
Entity Type:Individual
Prefix:
First Name:JUNIOR
Middle Name:SUSAN
Last Name:RUZVIDZO
Suffix:JR
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 1:2292 ROLLING ROCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4780
Mailing Address - Country:US
Mailing Address - Phone:614-843-4622
Mailing Address - Fax:
Practice Address - Street 1:2292 ROLLING ROCK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4780
Practice Address - Country:US
Practice Address - Phone:614-843-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN159499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse