Susan Margaret Bacheller, CPNP
Individual provider Active NPI Pediatric Nurse Practitioner · Fort Gratiot, MI
NPI 1477529600 · NPPES record last updated Apr 8, 2021
Key facts
- NPI
- 1477529600
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 4704136802 (MI)
- Practice address
- 4190 24TH Ave Ste 204
Fort Gratiot, MI 48059-3884 - Phone
- (810) 216-1000
- Fax
- (810) 216-3138
- NPI assigned
- Feb 27, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
Interoperability endpoints
- susan.bacheller.1@11357.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 4704136802 | MI | Yes |
Addresses
Primary practice location
4190 24TH Ave Ste 204
Fort Gratiot, MI 48059-3884
Mailing address
4190 24TH Ave Ste 204
Fort Gratiot, MI 48059-3884
Phone (810) 216-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704136802 | Other | MI | LICENSE |
Other providers in Fort Gratiot, MI
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- Cheyanne Avery
- Addison Dru Bailey
- Kelsey Katherine Baker
- Carmen Barks
- Abigail Josephine Barnum
- Paul Leonard Barr
All providers in Fort Gratiot, MI · Pediatric Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.