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General NPI Number Information
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NPI Number | 1235342015
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Entity Type | Individual
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Provider Name | SUSANNE MARIE RADEMACHER NP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 7421 PARKVIEW DR
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City | SAINT PAUL
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State | MN
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Zip | 55112-4118
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Country | US
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Telephone | 763-784-1179
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Fax |
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Provider Business Mailing Address
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Address Line | 7421 PARKVIEW DR
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City | SAINT PAUL
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State | MN
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Zip | 55112-4118
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Country | US
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Telephone | 763-784-1179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R0686178
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R68617-8
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License Number State | MN
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