Provider Demographics
NPI:1568420016
Name:RICE, SUSANNE O (FAMILY NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:O
Last Name:RICE
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3960 S ELLAMAE RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48363-2830
Mailing Address - Country:US
Mailing Address - Phone:248-391-4025
Mailing Address - Fax:586-421-1744
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5720
Practice Address - Country:US
Practice Address - Phone:586-421-1740
Practice Address - Fax:586-421-1744
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116417363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34780040Medicare UPIN