Individual
SUSAN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18000 W 9 MILE RD STE 525, SOUTHFIELD, MI 48075-4080
(248) 327-6196
Mailing address
18000 W 9 MILE RD STE 525, SOUTHFIELD, MI 48075-4080
(248) 327-6196
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
4704310011
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704310011
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704310011
NURSING LICENSE NUMBER
MI
Enumeration date
12/16/2021
Last updated
04/30/2024
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