Provider Demographics
NPI:1235240854
Name:CRONER, SUSAN MARIE (NP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:CRONER
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:BAKKER-CRONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-8194
Practice Address - Street 1:2150 GETTLER ST STE 400
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2385
Practice Address - Country:US
Practice Address - Phone:219-865-0893
Practice Address - Fax:219-865-3599
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001197A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200515670Medicaid
P00212275OtherRAILROAD MEDICARE
P69943Medicare UPIN