Healthcare Provider Details

I. General information

NPI: 1902894348
Provider Name (Legal Business Name): SUZANNE M OLIVER RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARLSON PKWY MAIL ROUTE CP320
MINNETONKA MN
55305-5359
US

IV. Provider business mailing address

40421 COUNTY ROAD 90
MAZEPPA MN
55956-9801
US

V. Phone/Fax

Practice location:
  • Phone: 952-992-2000
  • Fax: 952-992-3039
Mailing address:
  • Phone: 612-599-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number238908-21
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: