Provider Demographics
NPI:1336738327
Name:BLYTH, SUSAN M (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BLYTH
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 1:305 JOFFRE ST
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-3820
Mailing Address - Country:US
Mailing Address - Phone:724-674-6996
Mailing Address - Fax:
Practice Address - Street 1:305 JOFFRE ST
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-3820
Practice Address - Country:US
Practice Address - Phone:724-674-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN278513L163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health