Provider Demographics
NPI:1720841034
Name:POSTLETHWAIT, SUSAN TROWBRIDGE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:TROWBRIDGE
Last Name:POSTLETHWAIT
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 1:504 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1604
Mailing Address - Country:US
Mailing Address - Phone:304-266-0076
Mailing Address - Fax:
Practice Address - Street 1:504 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:PADEN CITY
Practice Address - State:WV
Practice Address - Zip Code:26159-1604
Practice Address - Country:US
Practice Address - Phone:304-266-0076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821206228Medicaid
WV125555553494Medicaid
WV1356607394Medicaid