Provider Demographics
NPI:1528168929
Name:WENTE, SUSAN MAGEE (CNM)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MAGEE
Last Name:WENTE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W NORTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337
Mailing Address - Country:US
Mailing Address - Phone:231-519-1081
Mailing Address - Fax:231-652-3247
Practice Address - Street 1:116 W NORTHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-519-1081
Practice Address - Fax:231-652-3247
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704198231367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
35177OtherHPM
MI4704198231OtherSTATE LIC