Provider Demographics
NPI:1396780938
Name:WIECHELMAN, SUSAN M (RN, CRNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WIECHELMAN
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17722 CRESTLAND RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1365
Mailing Address - Country:US
Mailing Address - Phone:216-486-0982
Mailing Address - Fax:
Practice Address - Street 1:88 CENTER RD
Practice Address - Street 2:SUITE 280
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2700
Practice Address - Country:US
Practice Address - Phone:440-232-5215
Practice Address - Fax:440-786-8554
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner