Individual
SUSAN MARY KILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,MSN,NP
Contact information
Practice address
NORTHWEST MICHIGAN COMMUNITY HEALTH AGENCY, 220 W. GARFIELD STREET, CHARLEVOIX, MI 49720
(231) 547-6523
(231) 547-6238
Mailing address
107 WOOD ST, CHARLEVOIX, MI 49720-1626
(231) 547-5871
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704087772
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SK087772
BCBSM
MI
Enumeration date
04/06/2007
Last updated
07/08/2007
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