IndividualActive
Marisue Susman, NP
NPI 1205124377 · Pediatric Nurse Practitioner · Meridian, ID
Provider details
- NPI number
- 1205124377
- Entity type
- Individual
- Primary specialty
- Pediatric Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- License
- NP-1488A (ID)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1620 S Celebration Ave
Meridian, ID 83642-2779
Phone: (208) 884-1030
Fax: (208) 884-3058
Approximate (ZIP-level) locationGet directions
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Registry dates
- Enumerated
- 2011-07-11
- Last updated
- 2015-10-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.