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General NPI Number Information
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NPI Number | 1902894348
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Entity Type | Individual
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Provider Name | SUZANNE M OLIVER RN, CNP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 401 CARLSON PKWY MAIL ROUTE CP320
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City | MINNETONKA
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State | MN
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Zip | 55305-5359
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Country | US
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Telephone | 952-992-2000
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Fax | 952-992-3039
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Provider Business Mailing Address
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Address Line | 40421 COUNTY ROAD 90
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City | MAZEPPA
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State | MN
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Zip | 55956-9801
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Country | US
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Telephone | 612-599-9869
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 238908-21
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License Number State | MD
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