Provider Demographics
NPI:1124601745
Name:DUPONT, SUSAN M
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:DUPONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 E GRAND BLANC RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2700
Mailing Address - Country:US
Mailing Address - Phone:231-944-9158
Mailing Address - Fax:
Practice Address - Street 1:2037 E GRAND BLANC RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2700
Practice Address - Country:US
Practice Address - Phone:231-944-9158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program