Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704203066 | MI |
NPI | 1023015104 |
---|---|
Provider Name | Mrs. Suzanne A Blanchard |
First Address | Prudenville, MI 48651-0019 |
Second Address | Prudenville, MI 48651-0019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 21/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4577440 TYPE 10 | (05) | MI |
5008702190 | BLUE CROSS BLUE SHIELD (01) | MI |
MB016102 | DEA (01) | MI |
P43636 | (02) | MI |