Provider Demographics
NPI:1477857324
Name:GODAIR, SUSAN JENNIFER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JENNIFER
Last Name:GODAIR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:JENNIFER
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1201 E MICHIGAN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1853
Mailing Address - Country:US
Mailing Address - Phone:517-205-1431
Mailing Address - Fax:517-205-1432
Practice Address - Street 1:1201 E MICHIGAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1853
Practice Address - Country:US
Practice Address - Phone:517-205-4800
Practice Address - Fax:517-205-1432
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005936363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical