Provider Demographics
NPI:1104067917
Name:KERR, SUSANNA MARIE (RN)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:MARIE
Last Name:KERR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 MALLARD CIR W
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9222
Mailing Address - Country:US
Mailing Address - Phone:740-366-7497
Mailing Address - Fax:
Practice Address - Street 1:1538 MALLARD CIR W
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9222
Practice Address - Country:US
Practice Address - Phone:740-366-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.344275163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health