Provider Demographics
NPI:1023239308
Name:NUENKE, SUSAN KAREEN
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAREEN
Last Name:NUENKE
Suffix:
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 1:6977 OAK MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9099
Mailing Address - Country:US
Mailing Address - Phone:513-759-2778
Mailing Address - Fax:
Practice Address - Street 1:6977 OAK MANOR DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9099
Practice Address - Country:US
Practice Address - Phone:513-759-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2716403374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2716403Medicaid