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Deactivated NPI 1003373994 Deactivated / Inactive NPI Female Practitioner

Susan Marie List , LPN

Licensed Practical Nurse • Beaverton, MI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Susan List has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date February 27, 2019
NPI Deactivation Date August 25, 2021
Total Practice Duration ~2 Years of Practice (2019 – 2021)

Professional Overview & Biography Verified Profile Summary

Susan List, LPN was a registered Licensed Practical Nurse practicing in Beaverton, MI. Throughout an active medical career spanning 2 years, Susan List provided care at the practice location at 129 RIVERSIDE DR until profile deactivation on 2021-08-25.

Practice Location & Contact Primary Location

Practice Address

129 Riverside Dr

Beaverton, MI 486129468

Telephone 9899093245

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Beaverton, MI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.0 Yrs
Regional Practice Density
1 Specialists

Practicing in Beaverton, MI (4550 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License MI 4703098724

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated August 25, 2021

Record deactivated on August 25, 2021

NPI Profile Active February 27, 2019

NPI status registered as active in NPPES database

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Updated Practice Location February 27, 2019

Registered at 129 RIVERSIDE DR, BEAVERTON, MI 486129468 (Tel: 9899093245)

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Updated Business Mailing Address February 27, 2019

Registered at 129 RIVERSIDE DR, BEAVERTON, MI 486129468 (Tel: 9899093245)

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Provider Name / Credentials Updated February 27, 2019

Recorded as SUSAN LIST, LPN

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Medical Taxonomy / Specialty Registered (Primary Specialty) February 27, 2019

Licensed Practical Nurse (License #4703098724 in MI)

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Initial NPI Registration & Enumeration February 27, 2019

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1003373994
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: February 27, 2019
Last Update: February 27, 2019
Deactivation Date: August 25, 2021

Mailing Address

129 Riverside Dr

Beaverton, MI 486129468

Phone: 9899093245

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.