Healthcare Provider Details

I. General information

NPI: 1730500430
Provider Name (Legal Business Name): SUSAN MICHELLE BROCK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN MICHELLE SLAWSON AGPCNP-BC

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LIFELINE COMMUNITY HEALTHCARE 6150 OAK TREE BLVD STE 200
INDEPENDENCE OH
44131
US

IV. Provider business mailing address

1925 ASHLAND CITY RD APT 207
CLARKSVILLE TN
37043-5296
US

V. Phone/Fax

Practice location:
  • Phone: 800-897-9177
  • Fax:
Mailing address:
  • Phone: 931-801-0502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22668
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95019712
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3011567
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: