Provider Demographics
NPI:1780021147
Name:BARNES, SUSAN ANN (PMHNP-BC, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANN
Last Name:BARNES
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4488 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ECORSE
Mailing Address - State:MI
Mailing Address - Zip Code:48229-1027
Mailing Address - Country:US
Mailing Address - Phone:313-740-6010
Mailing Address - Fax:
Practice Address - Street 1:4488 1ST ST
Practice Address - Street 2:
Practice Address - City:ECORSE
Practice Address - State:MI
Practice Address - Zip Code:48229-1027
Practice Address - Country:US
Practice Address - Phone:313-740-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-25
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704267775163W00000X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health