Individual
MRS. SUSAN MARIE WHITTAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Mailing address
7232 JUSTIN WAY, MENTOR, OH 44060-4881
(440) 578-8200
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN 315915
OH
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN.CNP.12685
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0064383
—
OH
Enumeration date
03/01/2007
Last updated
02/09/2021
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