Provider Demographics
NPI:1588658264
Name:HUGHES, SUSAN E (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:HUGHES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9268 LARCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9313
Mailing Address - Country:US
Mailing Address - Phone:231-276-5147
Mailing Address - Fax:231-276-5147
Practice Address - Street 1:825 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1592
Practice Address - Country:US
Practice Address - Phone:989-731-2100
Practice Address - Fax:989-731-7792
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704083625367500000X
IL209003749367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered