Susan Obhof
Individual provider Active NPI Nurse's Aide · Jefferson, OH
NPI 1609413400 · NPPES record last updated Nov 30, 2019
Key facts
- NPI
- 1609413400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- 401982800717 (OH)
- Practice address
- 1600 Lenox New Lyme Rd TRLR 49
Jefferson, OH 44047-9562 - Phone
- (440) 645-0339
- NPI assigned
- Nov 30, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 401982800717 | OH | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 401982800717 | OH | Yes |
Addresses
Primary practice location
1600 Lenox New Lyme Rd TRLR 49
Jefferson, OH 44047-9562
Mailing address
1600 Lenox New Lyme Rd TRLR 49
Jefferson, OH 44047-9562
Phone (440) 645-0339
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0348586 | Medicaid | OH |
Other providers in Jefferson, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.