Healthcare Provider Details

I. General information

NPI: 1053874248
Provider Name (Legal Business Name): SUZANNE KATHLEEN DUBUQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7743 GRAND RIVER RD STE 101
BRIGHTON MI
48114-9349
US

IV. Provider business mailing address

3694 EAGER RD
HOWELL MI
48855-9778
US

V. Phone/Fax

Practice location:
  • Phone: 810-494-5433
  • Fax:
Mailing address:
  • Phone: 517-294-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704207173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: