Individual
SUSHA THOMAS PANICKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC, FNP-BC
Contact information
Practice address
42669 GARFIELD RD, CLINTON TOWNSHIP, MI 48038-1653
(800) 395-3223
Mailing address
6549 TOWN CENTER DR STE A, CLARKSTON, MI 48346-4824
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704240933
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704240933
MI
Other
Enumeration date
01/09/2007
Last updated
02/28/2022
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