Provider Demographics
NPI:1215986955
Name:DORNAN, SUSAN ELIZABETH (CNM)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:DORNAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-617-1823
Mailing Address - Fax:440-617-0884
Practice Address - Street 1:29160 CENTER RIDGE RD
Practice Address - Street 2:SUITE M
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5225
Practice Address - Country:US
Practice Address - Phone:440-835-6996
Practice Address - Fax:440-808-9738
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNM07751367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601438Medicaid
OH341542312126OtherCARESOURCE
OH000000377270OtherANTHEM BC/BS
OH350112OtherWELLCARE
OH350112OtherWELLCARE
OHQ56830Medicare UPIN
OH2601438Medicaid
OHNM03261Medicare PIN