Healthcare Provider Details

I. General information

NPI: 1508503525
Provider Name (Legal Business Name): SUSANA E. RICHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANA ELIZABETH GONZALEZ DNP, APRN, CNP

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 9TH ST SE STE 1
ROCHESTER MN
55904-6400
US

IV. Provider business mailing address

210 9TH ST SE STE 1
ROCHESTER MN
55904-6400
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-3443
  • Fax:
Mailing address:
  • Phone: 818-414-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2459743
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9635
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: