Provider Demographics
NPI:1457588584
Name:HORNYAK, SUE (CNP)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HORNYAK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 TABS DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9562
Mailing Address - Country:US
Mailing Address - Phone:330-563-0618
Mailing Address - Fax:330-563-0604
Practice Address - Street 1:3730 TABS DR
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-9562
Practice Address - Country:US
Practice Address - Phone:330-563-0618
Practice Address - Fax:330-563-0604
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.194342OtherLICENSE
OH0149687Medicaid