Individual
MISS SUSAN MICHELLE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
LIFELINE COMMUNITY HEALTHCARE, 6150 OAK TREE BLVD STE 200, INDEPENDENCE, OH 44131
(800) 897-9177
Mailing address
1925 ASHLAND CITY RD, APT 207, CLARKSVILLE, TN 37043-5296
(931) 801-0502
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3011567
KY
363LA2200X
Adult Health Nurse Practitioner
Primary
22668
TN
363LA2200X
Adult Health Nurse Practitioner
95019712
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000855421
ANTHEM
IN
05
—
0099280
—
OH
05
—
201209630
—
IN
Enumeration date
12/23/2013
Last updated
04/16/2026
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