Provider Demographics
NPI:1740387075
Name:MERRELL, SUSAN E (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:E
Last Name:MERRELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:WEHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-9411
Mailing Address - Fax:989-362-9925
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3349
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704140425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4539637Medicaid
MIM61830012Medicare PIN
MIP96281Medicare UPIN