Provider Demographics
NPI:1245843077
Name:WALTERS, SUZANNE KAY
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KAY
Last Name:WALTERS
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 1:5923 COUNTY ROAD 29
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9734
Mailing Address - Country:US
Mailing Address - Phone:419-362-2735
Mailing Address - Fax:
Practice Address - Street 1:5923 COUNTY ROAD 29
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-9734
Practice Address - Country:US
Practice Address - Phone:419-362-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health