MISS SUSAN MICHELLE BROCK NP NPI 1730500430

NPI Information

NPI: 1730500430
Provider Name: MISS SUSAN MICHELLE BROCK, NP
Classification: Nurse Practitioner - 363LA2200X
Entity Type: Individual

Specialization: Adult Health

PECOS Registration: Yes

Address:
LIFELINE COMMUNITY HEALTHCARE
6150 OAK TREE BLVD STE 200
INDEPENDENCE, OH
ZIP 44131
Phone: (800) 897-9177
Get Directions

MISS Susan Michelle Brock, NP is an adult health nurse practitioner in Independence, OH. MISS Susan Michelle Brock, NP NPI is 1730500430. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

LIFELINE COMMUNITY HEALTHCARE
6150 OAK TREE BLVD STE 200
INDEPENDENCE, OH
ZIP 44131
Phone: (800) 897-9177

The NPI 1730500430 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/23/2013 and was last updated on 12/16/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363L00000X	Nurse Practitioner		3011567	KENTUCKY	No
2	363LA2200X	Nurse Practitioner	Adult Health	22668	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000000855421	OTHER	INDIANA	ANTHEM
2	201209630	MEDICAID	INDIANA
3	0099280	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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