Provider Demographics
NPI:1124042445
Name:CARL, SUZANNE E (RN CS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:E
Last Name:CARL
Suffix:
Gender:F
Credentials:RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BAKER ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-2157
Mailing Address - Country:US
Mailing Address - Phone:231-733-6607
Mailing Address - Fax:231-737-0534
Practice Address - Street 1:2700 BAKER ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-2157
Practice Address - Country:US
Practice Address - Phone:231-733-6607
Practice Address - Fax:231-737-0534
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704082234163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3507951Medicaid