Basic Information
| Provider Information | |||||||||
| NPI: | 1912949801 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LINN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 COURT ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893457000 | ||||||||
| FaxNumber: | 9893457479 | ||||||||
| Practice Location | |||||||||
| Address1: | 611 COURT ST | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486619390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893457000 | ||||||||
| FaxNumber: | 9893457479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4704176730 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363LF0000X | 4704176730 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4624578 | 05 | MI | MEDICAID |