Provider Demographics
NPI:1275936445
Name:KNOERR, SUSAN M (DNP,FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:KNOERR
Suffix:
Gender:F
Credentials:DNP,FNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9249 W LAKE CITY RD
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9602
Mailing Address - Country:US
Mailing Address - Phone:989-422-5122
Mailing Address - Fax:
Practice Address - Street 1:439 S ROSS ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:MI
Practice Address - Zip Code:48612-9101
Practice Address - Country:US
Practice Address - Phone:989-246-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily