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NPI Code Detail

MEDICARE: ELIZABETH SUZANNE HERNDEN FNP-BC

MEDICARE: ELIZABETH SUZANNE HERNDEN FNP-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
1363LF0000XFamily Nurse Practitioner4704273503MI
2364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist4704273503MI

General Provider Information

NPI Number : 1215274907
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH SUZANNE HERNDEN FNP-BC
Provider Business Mailing Address
First Line : 1000 HOUGHTON AVE
Second Line :
City : SAGINAW
State : MI
Zip : 48602-5303
Country : US
Telephone Number : 989-558-6425
Fax Number : 989-746-7723
Provider Business Practice Location Address
First Line : 3201 HALLMARK CT
Second Line :
City : SAGINAW
State : MI
Zip : 48603-2109
Country : US
Telephone Number : 989-790-5990
Fax Number : 989-790-5991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2013
Last Update Date : 02/11/2026

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