Healthcare Provider Details

I. General information

NPI: 1114903325
Provider Name (Legal Business Name): SUSAN TORKELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SAINT FRANCIS AVE SUITE 200
SHAKOPEE MN
55379-3374
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD CREDENTIALING
MINNEAPOLIS MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-7750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28593
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: