Provider Demographics
NPI:1205431004
Name:SWEIGERT, SUSAN JOAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOAN
Last Name:SWEIGERT
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 1:1905 ROCKEFELLER RD
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1941
Mailing Address - Country:US
Mailing Address - Phone:440-749-7859
Mailing Address - Fax:
Practice Address - Street 1:1905 ROCKEFELLER RD
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1941
Practice Address - Country:US
Practice Address - Phone:440-749-7859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4302249Medicaid