Healthcare Provider Details

I. General information

NPI: 1306918644
Provider Name (Legal Business Name): SUZANNE J DYNNESON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S CENTURY AVE
WAUNAKEE WI
53597-2386
US

IV. Provider business mailing address

1808 W BELTLINE HWY
MADISON WI
53713-2334
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-4315
  • Fax: 608-850-1606
Mailing address:
  • Phone: 608-280-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7530-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: