Provider Demographics
NPI:1427716497
Name:PHILABAUM, SUZANNE LEEANN
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LEEANN
Last Name:PHILABAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-2549
Mailing Address - Country:US
Mailing Address - Phone:330-621-2174
Mailing Address - Fax:
Practice Address - Street 1:777 S LAWN AVE
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2549
Practice Address - Country:US
Practice Address - Phone:330-621-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401579431013376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide