Provider Demographics
NPI:1750430948
Name:CORWIN, SUSAN F (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:CORWIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 MEDICAL CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7823
Mailing Address - Country:US
Mailing Address - Phone:231-935-8000
Mailing Address - Fax:231-935-8099
Practice Address - Street 1:1400 MEDICAL CAMPUS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7823
Practice Address - Country:US
Practice Address - Phone:231-935-8000
Practice Address - Fax:231-935-8099
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156874363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B86016OtherMEDICARE PTAN
MI431469Medicaid
MI0B86016OtherMEDICARE PTAN
MION31510Medicare ID - Type Unspecified