Individual
MRS. SUSIE MARTHA IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
427 OREGON ST APT 7, CINCINNATI, OH 45202-1634
(513) 807-5707
Mailing address
427 OREGON ST APT 7, CINCINNATI, OH 45202-1634
(513) 807-5707
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004262
OH
363AM0700X
Medical Physician Assistant
50.004262
OH
363AS0400X
Surgical Physician Assistant
50.004262
OH
Other
Enumeration date
05/15/2015
Last updated
05/16/2015
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