Provider Demographics
NPI:1588764260
Name:MICHALOWSKI, SUSAN M (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MICHALOWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4084 OKEMOS RD STE A
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3258
Mailing Address - Country:US
Mailing Address - Phone:517-347-4848
Mailing Address - Fax:
Practice Address - Street 1:4084 OKEMOS RD STE A
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3258
Practice Address - Country:US
Practice Address - Phone:517-347-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114720363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N97220Medicare ID - Type Unspecified
MIS56120Medicare UPIN