Provider Demographics
NPI:1336496793
Name:HURD, SUEANN ISABELLA (NP)
Entity Type:Individual
Prefix:
First Name:SUEANN
Middle Name:ISABELLA
Last Name:HURD
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2070 BIDDLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-225-9100
Practice Address - Fax:734-225-9176
Is Sole Proprietor?:No
Enumeration Date:2012-08-04
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704244549363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H28865OtherBLUE CROSS
12427444OtherCAQH
1144634403OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H28865OtherBLUE CROSS