Healthcare Provider Details

I. General information

NPI: 1528168929
Provider Name (Legal Business Name): SUSAN MAGEE WENTE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W NORTHLAND DRIVE
NEWAYGO MI
49337
US

IV. Provider business mailing address

116 W NORTHLAND DRIVE
NEWAYGO MI
49337
US

V. Phone/Fax

Practice location:
  • Phone: 231-519-1081
  • Fax: 231-652-3247
Mailing address:
  • Phone: 231-519-1081
  • Fax: 231-652-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704198231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: