Provider Demographics
NPI:1811905508
Name:WARNER, SUSANNA (PA, LLP)
Entity type:Individual
Prefix:
First Name:SUSANNA
Middle Name:
Last Name:WARNER
Suffix:
Gender:F
Credentials:PA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CAMPUS RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-839-3385
Mailing Address - Fax:989-839-1491
Practice Address - Street 1:4201 CAMPUS RIDGE DR STE 3950
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6131
Practice Address - Country:US
Practice Address - Phone:989-839-3385
Practice Address - Fax:989-839-1491
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008248103T00000X
MI5601007902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No103T00000XBehavioral Health & Social Service ProvidersPsychologist