Provider Demographics
NPI:1871934604
Name:KREBS, SUSAN M (CNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:KREBS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 NEAL ZICK RD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9287
Practice Address - Country:US
Practice Address - Phone:419-933-2811
Practice Address - Fax:419-933-4502
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA. 14720-NP363LP2300X
OHAPRN.CNP.14720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088342Medicaid
OHCOA. 14720-NPOtherLICENSE
OHCOA. 14720-NPOtherLICENSE