Provider Demographics
NPI:1801899083
Name:VILD, SUSAN L (MSN, RN, FNP C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:VILD
Suffix:
Gender:F
Credentials:MSN, RN, FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2815 DUSTIN RD
Mailing Address - Street 2:STE C
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3344
Mailing Address - Country:US
Mailing Address - Phone:419-691-6781
Mailing Address - Fax:419-691-0082
Practice Address - Street 1:2815 DUSTIN RD
Practice Address - Street 2:STE C
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3344
Practice Address - Country:US
Practice Address - Phone:419-691-6781
Practice Address - Fax:419-691-0082
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.05403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2223061Medicaid
OHNP08022Medicare ID - Type Unspecified