Individual
SUSAN LYDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6847 N CHESTNUT ST, RAVENNA, OH 44266-3929
(330) 297-0811
Mailing address
771 N FREEDOM ST, RAVENNA, OH 44266-2470
(330) 296-4816
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN193077
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000377168
ANTHEM PROVIDER NUMBER
OH
05
—
2002782
—
OH
Enumeration date
01/02/2007
Last updated
06/29/2011
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