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NPI Code Detail

MEDICARE: SUSAN M EGGL CRNA

MEDICARE: SUSAN M EGGL CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist4704124546MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2430056904OTHERMIMEDICARE RAIL ROAD TSC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3430B810310OTHERMIBCBS TSC

General Provider Information

NPI Number : 1568456309
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN M EGGL CRNA
Provider Business Mailing Address
First Line : 4100 PARK FOREST DR
Second Line : SUITE 210
City : TRAVERSE CITY
State : MI
Zip : 49684-7331
Country : US
Telephone Number : 231-935-5770
Fax Number : 231-935-0747
Provider Business Practice Location Address
First Line : 4100 PARK FOREST DR
Second Line : SUITE 210
City : TRAVERSE CITY
State : MI
Zip : 49684-7331
Country : US
Telephone Number : 231-935-5770
Fax Number : 231-935-0747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 04/14/2015

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Directions to “ SUSAN M EGGL CRNA” Practice Location

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