Provider Demographics
NPI:1699782300
Name:HATFIELD, SUSAN M (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 SEDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-7514
Mailing Address - Country:US
Mailing Address - Phone:513-722-5701
Mailing Address - Fax:513-677-2404
Practice Address - Street 1:1068 SEDGEFIELD CT
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-7514
Practice Address - Country:US
Practice Address - Phone:513-722-5701
Practice Address - Fax:513-677-2404
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001572363AM0700X
KYPA1908363AM0700X
FLPA9102015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant