Healthcare Provider Details

I. General information

NPI: 1013996479
Provider Name (Legal Business Name): SUSAN M SMITH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39450 W TWELVE MILE RD
NOVI MI
48377-3600
US

IV. Provider business mailing address

5623 E DUNBAR RD
MONROE MI
48161-9127
US

V. Phone/Fax

Practice location:
  • Phone: 248-344-8008
  • Fax:
Mailing address:
  • Phone: 734-241-3891
  • Fax: 734-241-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704168305
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: