Provider Demographics
NPI:1780270025
Name:PEACE, SUSAN JON
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JON
Last Name:PEACE
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 1:4750 E MIAMI RIVER RD APT A
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9403
Mailing Address - Country:US
Mailing Address - Phone:513-353-4233
Mailing Address - Fax:
Practice Address - Street 1:4750 E MIAMI RIVER RD APT A
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9403
Practice Address - Country:US
Practice Address - Phone:513-353-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker