Healthcare Provider Details

I. General information

NPI: 1174745715
Provider Name (Legal Business Name): SUSAN M KARNITZ CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN M LARSON CNS

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BEAM AVENUE
MAPLEWOOD MN
55109
US

IV. Provider business mailing address

9289 JERGEN AVENUE SOUTH
COTTAGE GROVE MN
55016
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-7628
  • Fax: 651-232-7240
Mailing address:
  • Phone: 651-326-7628
  • Fax: 651-232-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberR153383-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: