Provider Demographics
NPI:1386343366
Name:SMITH, SUZANNE
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8680 SOMMER RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49111-9660
Mailing Address - Country:US
Mailing Address - Phone:269-845-5930
Mailing Address - Fax:
Practice Address - Street 1:8680 SOMMER RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49111-9660
Practice Address - Country:US
Practice Address - Phone:269-845-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28183760A163W00000X
MI4704280739163W00000X
FLRN9605107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse