1720063431 NPI number — SUSAN ELIZABETH WRIGHT NP, CNM

Table of content: DR. DANA LIPSKIS DDS (NPI 1235547969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063431 NPI number — SUSAN ELIZABETH WRIGHT NP, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRIGHT
Provider First Name:
SUSAN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720063431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37360 52ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAW PAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49079-9334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-207-4502
Provider Business Mailing Address Fax Number:
269-657-5996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 HAZEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAW PAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49079-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-657-6058
Provider Business Practice Location Address Fax Number:
269-657-5996
Provider Enumeration Date:
12/14/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  4704098998 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: 4704098998 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)