Individual
SUSAN CLOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
30200 TELEGRAPH RD, SUITE 220, BINGHAM FARMS, MI 48025-4502
(248) 258-5058
Mailing address
5800 TRIPP RD, OSSEO, MI 49266-9594
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704209755
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104826887
—
MI
Enumeration date
04/25/2006
Last updated
06/11/2014
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