Suzanne Clark, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN.129253MIV Issued in OH

Practice address

109 W Main St
Alvordton, OH 43501-9763

Phone

(419) 924-2029

NPI assigned

Sep 16, 2016

Last updated

Sep 16, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Renewed Mind

  • Community/Behavioral Health Agency
  • Toledo, OH
  • NPI 1760749444
  NPD (past)
• Five County Alcohol/Drup Program in

  • Non-Pharmacy Dispensing Site
  • Alvordton, OH
  • NPI 1093772386
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1972051183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W MAIN ST",
            "city": "ALVORDTON",
            "state": "OH",
            "postal_code": "435019763",
            "telephone_number": "419-924-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 W MAIN ST",
            "city": "ALVORDTON",
            "state": "OH",
            "postal_code": "435019763",
            "telephone_number": "419-924-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SUZANNE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-16",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "PN.129253MIV",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery L Cornhill, LSW
• Five County Alcohol/Drup Program in
• Heather Galbraith, LSW
• Tina Kern, LPN
• Levi Marcellino Lopez

• Licensed Practical Nurse in Alvordton, OH
• Providers in Alvordton, OH by specialty
• Licensed Practical Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.