Provider Demographics
NPI:1962774141
Name:BENACH, SUSAN (MSN, RN, CCM, AACC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BENACH
Suffix:
Gender:F
Credentials:MSN, RN, CCM, AACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 FULLER RD
Mailing Address - Street 2:VA ANN ARBOR HEALTHCARE SYSTEM, CARDIOLOGY III-A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2303
Mailing Address - Country:US
Mailing Address - Phone:734-845-5781
Mailing Address - Fax:734-845-3018
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:VA ANN ARBOR HEALTHCARE SYSTEM, CARDIOLOGY III-A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:734-845-5781
Practice Address - Fax:734-845-3018
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145095163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management