MEDICARE: SUSAN CAMPITELLE ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0600X	Gerontology Registered Nurse	4704270638	MI
2	363LG0600X	Gerontology Nurse Practitioner	4704270638	MI

General Provider Information

NPI Number	:	1013261734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CAMPITELLE ANP-BC

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR
Second Line	:	PO BOX 0446 - LOBBY J
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	19000 ST JOES PKWY STE 330
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48152-1477
Country	:	US
Telephone Number	:	734-884-5263
Fax Number	:	734-884-5264

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	03/18/2025

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