Provider Demographics
NPI:1700074424
Name:WILSON, SUZANNE LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1419
Mailing Address - Country:US
Mailing Address - Phone:740-342-1754
Mailing Address - Fax:
Practice Address - Street 1:149 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1419
Practice Address - Country:US
Practice Address - Phone:740-342-1754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 214038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse