Provider Demographics
NPI:1396704763
Name:ADRIAN, SUSAN J (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:ADRIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67250
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7250
Mailing Address - Country:US
Mailing Address - Phone:402-328-8833
Mailing Address - Fax:402-328-2921
Practice Address - Street 1:55 PARK AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1121
Practice Address - Country:US
Practice Address - Phone:740-845-7600
Practice Address - Fax:740-845-7676
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN150849163W00000X
OHNP00603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH141867207028OtherCARESOURCE
OH2119764Medicaid
000000286657OtherANTHEM BCBS
OHP00354251OtherRRM
NP04184Medicare UPIN
OHP00354251OtherRRM