MEDICARE: CARRIE SURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	1328914	MN

General Provider Information

NPI Number	:	1093283020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE SURA

Provider Business Mailing Address
First Line	:	707 LUNDORFF DR STE 2
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5099
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 LUNDORFF DR STE 2
Second Line	:
City	:	SANDSTONE
State	:	MN
Zip	:	55072-5099
Country	:	US
Telephone Number	:	320-245-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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Directions to “ CARRIE SURA ” Practice Location

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