Provider Demographics
NPI:1255696019
Name:SCHWARTZ, SUSAN T (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:T
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:T
Other - Last Name:MORCOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17425 LOCHERBIE AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4158
Mailing Address - Country:US
Mailing Address - Phone:248-321-9610
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165843363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care