Basic Information
| Provider Information | |||||||||
| NPI: | 1558792796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPERRY-SUICH | ||||||||
| FirstName: | MEGHANN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | R.N | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SUICH | ||||||||
| OtherFirstName: | MEGHANN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | R.N | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4603 CULVER ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481253346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343637860 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 26650 EUREKA RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481804835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349553562 | ||||||||
| FaxNumber: | 7349553562 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2013 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 3407502 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.