Provider Demographics
NPI:1457593253
Name:DAMALIE, SUZZIETTE ABENA (LPN)
Entity Type:Individual
Prefix:
First Name:SUZZIETTE
Middle Name:ABENA
Last Name:DAMALIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 GREENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1830
Mailing Address - Country:US
Mailing Address - Phone:614-323-7920
Mailing Address - Fax:614-475-2425
Practice Address - Street 1:3229 GREENBROOK CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1830
Practice Address - Country:US
Practice Address - Phone:614-323-7920
Practice Address - Fax:614-475-2425
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129047 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse