Healthcare Provider Details

I. General information

NPI: 1265872261
Provider Name (Legal Business Name): SUZANNE LOIS ALDRICH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GOLF COURSE RD GRAND ITASCA CLINIC AND HOSPITAL
GRAND RAPIDS MN
55744-8648
US

IV. Provider business mailing address

721 10TH AVE NW
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3401
  • Fax:
Mailing address:
  • Phone: 218-326-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR102885-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: