Provider Demographics
NPI:1336745991
Name:VANNELLO, SUSAN LYNN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:VANNELLO
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 1:13820 LODGE DR
Mailing Address - Street 2:
Mailing Address - City:N ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4144
Mailing Address - Country:US
Mailing Address - Phone:440-364-3651
Mailing Address - Fax:
Practice Address - Street 1:13820 LODGE DR
Practice Address - Street 2:
Practice Address - City:N ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4144
Practice Address - Country:US
Practice Address - Phone:440-364-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker