Provider Demographics
NPI:1760434682
Name:MEYER, PAULA SUSAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUSAN
Last Name:MEYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 S LAKE LEELANAU DR
Mailing Address - Street 2:
Mailing Address - City:LAKE LEELANAU
Mailing Address - State:MI
Mailing Address - Zip Code:49653-9764
Mailing Address - Country:US
Mailing Address - Phone:231-256-9571
Mailing Address - Fax:
Practice Address - Street 1:3189 LOGAN VALLEY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4772
Practice Address - Country:US
Practice Address - Phone:231-932-1988
Practice Address - Fax:231-932-7693
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704121716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI518789810Medicaid
MIN28290003Medicare PIN