MEDICARE: MRS. SUSAN MARIE PLENCNER RN

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	163W00000X	Registered Nurse	4704196931	MI

General Provider Information

NPI Number	:	1225641723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN MARIE PLENCNER RN

Provider Business Mailing Address
First Line	:	10085 TENNYSON DR
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-3647
Country	:	US
Telephone Number	:	734-646-6981
Fax Number	:

Provider Business Practice Location Address
First Line	:	22670 HAGGERTY RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-2607
Country	:	US
Telephone Number	:	248-465-7300
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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