Provider Demographics
NPI:1306078530
Name:PICCIANO, SUSAN DIANE (CNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:PICCIANO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N PICKAWAY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1447
Mailing Address - Country:US
Mailing Address - Phone:740-420-8632
Mailing Address - Fax:740-420-8633
Practice Address - Street 1:600 N PICKAWAY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1447
Practice Address - Country:US
Practice Address - Phone:740-420-8632
Practice Address - Fax:740-420-8633
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10852-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2985962Medicaid