Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 35-063143 | OH |
Y | 2081P2900X | Pain Medicine | 35063143 | OH |
NPI | 1316915085 |
---|---|
Provider Name | Susan Marie Arceneaux |
First Address | Euclid, OH 44117-1714 |
Second Address | Medina, OH 44256-3331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 30/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0903080 | (05) | OH |
F 51808 | (02) | OH |