Healthcare Provider Details

I. General information

NPI: 1477095214
Provider Name (Legal Business Name): SUSAN REUTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

IV. Provider business mailing address

45627 STADLER ST
UTICA MI
48315-5939
US

V. Phone/Fax

Practice location:
  • Phone: 810-724-0591
  • Fax:
Mailing address:
  • Phone: 586-864-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704272466
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: