Individual
SUSAN C IANNICCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP, RD
Contact information
Practice address
231 SEASONS RD, SUITE 200, HUDSON, OH 44224
(330) 650-5110
(330) 650-5115
Mailing address
231 SEASONS RD, SUITE 200, HUDSON, OH 44224
(330) 650-5110
(330) 650-5115
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
LD5059
OH
363L00000X
Nurse Practitioner
Primary
NP07882
OH
363L00000X
Nurse Practitioner
RN286846
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2598765
—
OH
Enumeration date
12/11/2006
Last updated
08/02/2023
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