Provider Demographics
NPI:1932544434
Name:HUGHES, SUSAN DALE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DALE
Last Name:HUGHES
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 1:5270 FRAZIER GUY RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9709
Mailing Address - Country:US
Mailing Address - Phone:937-638-8023
Mailing Address - Fax:
Practice Address - Street 1:5270 FRAZIER GUY RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9709
Practice Address - Country:US
Practice Address - Phone:937-638-8023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH147284164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse