Individual
MS. SUSAN D YODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5270
(616) 455-5460
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704232041
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704232041
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4517854
—
MI
01
—
5008766360
BCBS
MI
Enumeration date
09/27/2005
Last updated
06/05/2013
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