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General NPI Number Information
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NPI Number | 1093966723
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Entity Type | Individual
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Provider Name | SUSAN PETERSON
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Gender | Female
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 384 N 3RD AVE
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City | FRUITPORT
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State | MI
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Zip | 49415-9788
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Country | US
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Telephone | 231-865-7706
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Fax | 231-865-7707
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Provider Business Mailing Address
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Address Line | 384 N 3RD AVE
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City | FRUITPORT
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State | MI
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Zip | 49415-9788
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Country | US
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Telephone | 231-965-7706
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 3501003027
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License Number State | MI
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