Provider Demographics
NPI:1215547583
Name:PAUGH, SUSAN RENEE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:PAUGH
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 1:161 EBERT RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26710-8008
Mailing Address - Country:US
Mailing Address - Phone:304-209-9728
Mailing Address - Fax:
Practice Address - Street 1:161 EBERT RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WV
Practice Address - Zip Code:26710-8008
Practice Address - Country:US
Practice Address - Phone:304-209-9728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant