1912142365 NPI number — PROF. SUSAN JANETTE FARUS-BROWN MSN, FNP-BC, CNP

Table of content: PROF. SUSAN JANETTE FARUS-BROWN MSN, FNP-BC, CNP (NPI 1912142365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912142365 NPI number — PROF. SUSAN JANETTE FARUS-BROWN MSN, FNP-BC, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARUS-BROWN
Provider First Name:
SUSAN
Provider Middle Name:
JANETTE
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912142365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
859 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43758-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-962-6111
Provider Business Mailing Address Fax Number:
740-962-1657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
716 ADAIR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-891-9000
Provider Business Practice Location Address Fax Number:
740-891-9001
Provider Enumeration Date:
12/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  COA.10266-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2964814 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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