Provider Demographics
NPI:1891185070
Name:SUCH, SUSANNA ELIZABETH (NP-C)
Entity Type:Individual
Prefix:
First Name:SUSANNA
Middle Name:ELIZABETH
Last Name:SUCH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DRAKE CT
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-9103
Mailing Address - Country:US
Mailing Address - Phone:269-492-5707
Mailing Address - Fax:
Practice Address - Street 1:521 E MICHIGAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3889
Practice Address - Country:US
Practice Address - Phone:269-349-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704185266163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse