Provider Demographics
NPI:1982008348
Name:MENARD, SUSAN JEAN (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:MENARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1135
Mailing Address - Country:US
Mailing Address - Phone:248-581-5729
Mailing Address - Fax:248-581-5643
Practice Address - Street 1:1310 N MACOMB ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3131
Practice Address - Country:US
Practice Address - Phone:344-574-0557
Practice Address - Fax:734-384-3778
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704241303363L00000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner