MEDICARE: MS. SUZANNE MARIE MAHONEY NP

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
1	363LF0000X	Family Nurse Practitioner	4704145293	MI

General Provider Information

NPI Number	:	1720220031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUZANNE MARIE MAHONEY NP

Provider Business Mailing Address
First Line	:	16151 19 MILE RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-228-1760
Fax Number	:

Provider Business Practice Location Address
First Line	:	16151 19 MILE RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1158
Country	:	US
Telephone Number	:	586-228-1760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	02/09/2021

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