Provider Demographics
NPI:1104848530
Name:ROBARGE, SUZAN C (RN NP)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:C
Last Name:ROBARGE
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MINERS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9625
Mailing Address - Country:US
Mailing Address - Phone:269-408-1688
Mailing Address - Fax:269-408-1692
Practice Address - Street 1:1030 MINERS RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9625
Practice Address - Country:US
Practice Address - Phone:269-408-1688
Practice Address - Fax:269-408-1692
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704141653363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4621834Medicaid
MI4621834Medicaid
N67860002Medicare ID - Type UnspecifiedMEDICARE PART B