Provider Demographics
NPI:1437206570
Name:WATSON, SUSAN E (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:WATSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30320 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1029
Mailing Address - Country:US
Mailing Address - Phone:239-849-8746
Mailing Address - Fax:
Practice Address - Street 1:23338 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1302
Practice Address - Country:US
Practice Address - Phone:248-399-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30822400Medicaid
FLAC958YMedicare PIN