Provider Demographics
NPI:1558492850
Name:WALKER, SUZETTE CAROL (NP)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:CAROL
Last Name:WALKER
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 1:120 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-3770
Mailing Address - Fax:810-648-3352
Practice Address - Street 1:170 ARGYLE STREET
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-5911
Practice Address - Country:US
Practice Address - Phone:810-648-3229
Practice Address - Fax:810-648-5404
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4334228Medicaid
MI0M97190058Medicare ID - Type Unspecified
MI4334228Medicaid