Provider Demographics
NPI:1972313799
Name:WALING, SUSAN (HCA, CNA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WALING
Suffix:
Gender:F
Credentials:HCA, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3362
Mailing Address - Country:US
Mailing Address - Phone:425-633-5193
Mailing Address - Fax:
Practice Address - Street 1:9412 ARBOR CT
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-3362
Practice Address - Country:US
Practice Address - Phone:425-633-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMIWA12032024554925376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty