Individual
MS. SUSAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
16700 S WATER TOWER DR, KINCHELOE, MI 49788-1637
(906) 495-5339
Mailing address
1421 YOUNG ST, SAULT SAINTE MARIE, MI 49783-3041
(906) 632-1988
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704142100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704142100
LICENSURE
MI
Enumeration date
01/22/2009
Last updated
01/22/2009
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