Individual
SUSAN R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
463 E CIRCLE DR, EAST LANSING, MI 48824-7500
(517) 884-6546
(517) 432-9460
Mailing address
804 SERVICE RD, A201, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704149259
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801119532
—
MI
Enumeration date
03/09/2010
Last updated
06/08/2016
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