Healthcare Provider Details

I. General information

NPI: 1215939723
Provider Name (Legal Business Name): SUZANNE ROSE MARTINI RN, MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 E MICHIGAN AVE
LANSING MI
48912-4018
US

IV. Provider business mailing address

1010 S HUGHES RD
HOWELL MI
48843-9123
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-7628
  • Fax: 517-346-7629
Mailing address:
  • Phone: 517-546-4938
  • Fax: 517-546-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704124912
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: