Provider Demographics
NPI:1154537363
Name:KEENER, SUZZANNE B (LPN)
Entity type:Individual
Prefix:MISS
First Name:SUZZANNE
Middle Name:B
Last Name:KEENER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TOWNSHIP ROAD 1404
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8920
Mailing Address - Country:US
Mailing Address - Phone:419-496-2444
Mailing Address - Fax:419-496-2337
Practice Address - Street 1:1634 ASHLAND COUNTY ROAD 1095
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-281-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN090994164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse