Individual
MARISUE SUSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1620 S CELEBRATION AVE, MERIDIAN, ID 83642-2779
(208) 884-1030
(208) 884-3058
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
NP-1488A
ID
Other
Enumeration date
07/11/2011
Last updated
10/27/2015
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