Provider Demographics
NPI:1265793525
Name:OSANTOWSKI, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:OSANTOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22150 GREENFIELD RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2535
Mailing Address - Country:US
Mailing Address - Phone:248-246-6566
Mailing Address - Fax:
Practice Address - Street 1:22150 GREENFIELD RD
Practice Address - Street 2:SUITE 203
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2535
Practice Address - Country:US
Practice Address - Phone:248-246-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703063451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse