Provider Demographics
NPI:1841220001
Name:BEATTY-PAGE, SUSAN Y (PAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:Y
Last Name:BEATTY-PAGE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MI
Mailing Address - Zip Code:48742-0279
Mailing Address - Country:US
Mailing Address - Phone:989-736-8157
Mailing Address - Fax:989-358-3763
Practice Address - Street 1:11745 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:OSSINEKE
Practice Address - State:MI
Practice Address - Zip Code:49766-9582
Practice Address - Country:US
Practice Address - Phone:989-471-2156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q66981Medicare UPIN