1861599755 NPI number — MS. SUSAN DIANE FEE LICENSED PROFESSIONA

Table of content: DR. ROBERT L SWEET DDS PA (NPI 1497830616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861599755 NPI number — MS. SUSAN DIANE FEE LICENSED PROFESSIONA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEE
Provider First Name:
SUSAN
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED PROFESSIONA
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:
1861599755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
343 ST LAWRENCE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAFAMORE HILLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44067-1175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-908-3840
Provider Business Mailing Address Fax Number:
330-908-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5475 LIBERTY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERMILION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-963-0402
Provider Business Practice Location Address Fax Number:
440-963-4018
Provider Enumeration Date:
09/20/2006

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: 101YM0800X , with the licence number:  C0007857 , 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)





Copyright © 2007-2024 www.npivalidator.com