Diaz, Susana

Diaz, Susana is an individual health care provider with primary practice located at 621 Memorial Dr Ste 403 , South Bend IN 46601-1074. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Diaz, Susana can be contacted via phone (574) 647-1405.

Contact Information

Primary practice address
621 Memorial Dr Ste 403 South Bend IN 46601-1074
Phone: (574) 647-1405
Fax: (574) 647-3970
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 09000225A Indiana

Profile Details

NPI number 1972857704
LBN Legal business name Diaz, Susana
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2012
Last updated Apr 1st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972857704 NPPES
Indiana Other 178420006 MEDICARE PTAN
Indiana MEDICAID 201132350 MEDICARE PTAN
Indiana Other 236040262 MEDICARE PTAN

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