Provider Demographics
NPI:1427285287
Name:ZIEMKE, SUZANNE MARIE (CNM RN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:ZIEMKE
Suffix:
Gender:F
Credentials:CNM RN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:MARIE
Other - Last Name:GODFREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD ROAD
Mailing Address - Street 2:SUITE 352
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-849-3041
Mailing Address - Fax:248-849-4106
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:STE 4E & 4F
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-4380
Practice Address - Fax:313-993-0692
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704223722367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32150029Medicare PIN