Provider Demographics
NPI:1447913397
Name:SUPER, JOYCE MARIE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:SUPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 DELAWARE CIR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-7852
Mailing Address - Country:US
Mailing Address - Phone:440-222-8751
Mailing Address - Fax:
Practice Address - Street 1:164 DELAWARE CIR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7852
Practice Address - Country:US
Practice Address - Phone:440-222-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty