Provider Demographics
NPI:1275816175
Name:EADELMAN, SUSAN E (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:EADELMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2607
Mailing Address - Country:US
Mailing Address - Phone:616-604-0096
Mailing Address - Fax:616-604-0095
Practice Address - Street 1:1091 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-604-0096
Practice Address - Fax:616-604-0095
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214274363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner