Basic Information
| Provider Information | |||||||||
| NPI: | 1841220001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATTY-PAGE | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | Y. | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 279 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487420279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897368157 | ||||||||
| FaxNumber: | 9893583763 | ||||||||
| Practice Location | |||||||||
| Address1: | 11745 US HIGHWAY 23 S | ||||||||
| Address2: | |||||||||
| City: | OSSINEKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497669582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894712156 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601003207 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.