Individual
SUSAN MARIE WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NBC-HIS
Contact information
Practice address
2404 WILDWOOD AVE, JACKSON, MI 49202-3927
(517) 788-7677
(517) 788-7679
Mailing address
2404 WILDWOOD AVE, JACKSON, MI 49202-3927
(517) 788-7677
(517) 788-7679
Taxonomy
Speciality
Code
Description
License number
State
332S00000X
Hearing Aid Equipment
Primary
3501002419
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540C802820
BLUE CROSS AND BLUE SHIELD OF MICHIGAN
MI
05
—
905258069
—
MI
Enumeration date
01/19/2010
Last updated
01/19/2010
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