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General NPI Number Information
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NPI Number | 1720063431
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Entity Type | Individual
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Provider Name | SUSAN ELIZABETH WRIGHT NP, CNM
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 509 HAZEN ST
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City | PAW PAW
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State | MI
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Zip | 49079-1057
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Country | US
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Telephone | 269-657-6058
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Fax | 269-657-5996
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Provider Business Mailing Address
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Address Line | 37360 52ND AVE
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City | PAW PAW
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State | MI
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Zip | 49079-9334
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Country | US
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Telephone | 269-207-4502
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Fax | 269-657-5996
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 4704098998
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 4704098998
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License Number State | MI
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