Provider Demographics
NPI:1407895303
Name:CREAGER, SUSAN M (MSN,APRN BC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:CREAGER
Suffix:
Gender:F
Credentials:MSN,APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M-283
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-349-1013
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-283
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-349-1013
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704117415364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8908767900OtherBCBS PIN
MI8908767900OtherBCBS PIN
MICA3050Medicare PIN
MI0N83140001Medicare PIN
MI890000775Medicare PIN
MI8908767900OtherBCBS PIN
383148262OtherEIN-HEALTHCARE MIDWEST