Provider Demographics
NPI:1336861186
Name:FOX, SUSAN LEANN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEANN
Last Name:FOX
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 1:263 DOUG CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-6302
Mailing Address - Country:US
Mailing Address - Phone:304-575-5956
Mailing Address - Fax:
Practice Address - Street 1:10434 SENECA TRL S
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1586
Practice Address - Country:US
Practice Address - Phone:304-645-1706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse