Individual
DR. AMY BLAKE SUSNOW
Active
Individual
DR. AMY BLAKE SUSNOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
56132
WI
207SG0201X
Clinical Genetics (M.D.) Physician
DR.0058101
CO
390200000X
Student in an Organized Health Care Education/Training Program
FE60028232
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028673
KAISER COMMERCIAL NUMBER
CO
Enumeration date
06/23/2006
Last updated
07/03/2022
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