Basic Information
| Provider Information | |||||||||
| NPI: | 1033683438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUSEC | ||||||||
| FirstName: | RITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BARTA | ||||||||
| OtherFirstName: | RITA | ||||||||
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| OtherCredential: | CNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3600 KOLBE RD STE 11 | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402224003 | ||||||||
| FaxNumber: | 4409604922 | ||||||||
| Practice Location | |||||||||
| Address1: | 3600 KOLBE RD STE 11 | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402224003 | ||||||||
| FaxNumber: | 4409604922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN.CNP.023200 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | APRN.CNP.023200 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.