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General NPI Number Information
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NPI Number | 1053526475
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Entity Type | Individual
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Provider Name | MRS. SUSANNE ELISABETH MICHELSON
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/02/2026
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Provider Practice Location Address
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Address Line | 4661 N PARKSIDE DR
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City | WAUWATOSA
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State | WI
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Zip | 53225-4447
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Country | US
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Telephone | 414-464-9785
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Fax |
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Provider Business Mailing Address
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Address Line | 4661 N PARKSIDE DR
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City | WAUWATOSA
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State | WI
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Zip | 53225-4447
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Country | US
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Telephone | 414-464-9785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 49287 - 030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 49287-030
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License Number State | WI
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