Provider Demographics
NPI:1720400492
Name:SUIDAN, RACHEL MARIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:MARIE
Last Name:SUIDAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:LAPORTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:950 VICTORS WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-926-4800
Mailing Address - Fax:734-973-0595
Practice Address - Street 1:23338 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:734-926-4800
Practice Address - Fax:734-973-0595
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276577367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife