Provider Demographics
NPI:1245436252
Name:BELL, SUE P
Entity type:Individual
Prefix:MS
First Name:SUE
Middle Name:P
Last Name:BELL
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 1:3050 MACK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5379
Mailing Address - Country:US
Mailing Address - Phone:513-981-6784
Mailing Address - Fax:513-215-9397
Practice Address - Street 1:3050 MACK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5379
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-215-9397
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.314438364S00000X
OHCOA08811NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2785866Medicaid