Healthcare Provider Details

I. General information

NPI: 1407882269
Provider Name (Legal Business Name): SUZANNE RUDI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZANNE ODENBACH

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2131
US

IV. Provider business mailing address

6545 FRANCE AVE S SUITE 210
EDINA MN
55435-2131
US

V. Phone/Fax

Practice location:
  • Phone: 952-928-2900
  • Fax: 952-928-2944
Mailing address:
  • Phone: 952-928-2900
  • Fax: 952-928-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9600
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: