Provider Demographics
NPI:1487362372
Name:BLUM, SUSAN LINDA
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:BLUM
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 1:669 OAK CT APT 1
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1239
Mailing Address - Country:US
Mailing Address - Phone:570-229-4645
Mailing Address - Fax:
Practice Address - Street 1:71 SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9631
Practice Address - Country:US
Practice Address - Phone:330-714-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider