Provider Demographics
NPI:1063183457
Name:HARTSHORN, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:HARTSHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 SANG RUN RD
Mailing Address - Street 2:
Mailing Address - City:CHLOE
Mailing Address - State:WV
Mailing Address - Zip Code:25235-7669
Mailing Address - Country:US
Mailing Address - Phone:304-377-0197
Mailing Address - Fax:
Practice Address - Street 1:625 SANG RUN RD
Practice Address - Street 2:
Practice Address - City:CHLOE
Practice Address - State:WV
Practice Address - Zip Code:25235-7669
Practice Address - Country:US
Practice Address - Phone:304-377-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant