Provider Demographics
NPI:1396346375
Name:FOX, SUSAN MELISSA (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MELISSA
Last Name:FOX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MELISSA
Other - Last Name:CAUDILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8513 STATE ROUTE 503 S
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:OH
Mailing Address - Zip Code:45311-8999
Mailing Address - Country:US
Mailing Address - Phone:937-336-9279
Mailing Address - Fax:
Practice Address - Street 1:100 ELMWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5402
Practice Address - Country:US
Practice Address - Phone:937-336-9279
Practice Address - Fax:937-384-0581
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.241067163WA0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)