Provider Demographics
NPI:1669554416
Name:HUTTER, SUSAN WELLS (CRNA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WELLS
Last Name:HUTTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 SAGANING RD
Mailing Address - Street 2:
Mailing Address - City:BENTLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48613-9632
Mailing Address - Country:US
Mailing Address - Phone:989-846-0983
Mailing Address - Fax:
Practice Address - Street 1:5161 CARDINAL PARK DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9435
Practice Address - Country:US
Practice Address - Phone:989-249-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205255367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered