MEDICARE: PAULA SUSAN MEYER FNP-C

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	363LF0000X	Family Nurse Practitioner	4704121716	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760434682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA SUSAN MEYER FNP-C

Provider Business Mailing Address
First Line	:	4028 S LAKE LEELANAU DR
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-9764
Country	:	US
Telephone Number	:	231-256-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	3189 LOGAN VALLEY RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-4772
Country	:	US
Telephone Number	:	231-932-1988
Fax Number	:	231-932-7693

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/26/2008

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