Individual
LISA SUSALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2412 WINDEMERE RD, BIRMINGHAM, MI 48009-7518
(248) 816-0578
Mailing address
2412 WINDEMERE RD, BIRMINGHAM, MI 48009-7518
(248) 816-0578
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704149927
MI
Other
Enumeration date
12/20/2013
Last updated
12/20/2013
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