Provider Demographics
NPI:1649005588
Name:LOUVAR, SUSAN R (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:R
Last Name:LOUVAR
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 MIAMI PATH
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-1333
Mailing Address - Country:US
Mailing Address - Phone:248-459-8862
Mailing Address - Fax:
Practice Address - Street 1:244 MIAMI PATH
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1333
Practice Address - Country:US
Practice Address - Phone:248-459-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191034363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health