Healthcare Provider Details

I. General information

NPI: 1235319377
Provider Name (Legal Business Name): BRIANNA L. SUCIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 12/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 PARK NICOLLET BLVD URGENT CARE-SLP
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD ATTN: KATLYN JOHNSON, CREDENTIALING
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3025
  • Fax:
Mailing address:
  • Phone: 952-883-6355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: