Provider Demographics
NPI:1689039109
Name:PAPPENHAGEN, SUZANNE FLETCHER
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:FLETCHER
Last Name:PAPPENHAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 OAKLAND AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3457
Mailing Address - Country:US
Mailing Address - Phone:302-299-9680
Mailing Address - Fax:
Practice Address - Street 1:4880 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-2010
Practice Address - Country:US
Practice Address - Phone:313-846-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program