Healthcare Provider Details

I. General information

NPI: 1932384310
Provider Name (Legal Business Name): SUSAN MARGARET MAHON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SUSAN MARGARET BROWN

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NORTH 4TH AVENUE
FERGUS FALLS MN
56537-1034
US

IV. Provider business mailing address

4162 LITTLE BOY RD NE
LONGVILLE MN
56655
US

V. Phone/Fax

Practice location:
  • Phone: 218-998-3778
  • Fax: 218-998-3187
Mailing address:
  • Phone: 218-363-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1632998
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: