Individual
SUSAN ANTKOVIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1728 DAYTON XENIA RD, XENIA, OH 45385-7119
(937) 458-2327
Mailing address
3570 EMPIRE DR, BEAVERCREEK, OH 45431-5787
(937) 458-2327
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN357125
OH
Other
Enumeration date
10/19/2015
Last updated
10/19/2015
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