Provider Demographics
NPI:1558792796
Name:SPERRY-SUICH, MEGHANN (RN)
Entity Type:Individual
Prefix:
First Name:MEGHANN
Middle Name:
Last Name:SPERRY-SUICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEGHANN
Other - Middle Name:
Other - Last Name:SUICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4603 CULVER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-3346
Mailing Address - Country:US
Mailing Address - Phone:734-363-7860
Mailing Address - Fax:
Practice Address - Street 1:26650 EUREKA RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4835
Practice Address - Country:US
Practice Address - Phone:734-955-3562
Practice Address - Fax:734-955-3562
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3407502163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse