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General NPI Number Information
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NPI Number | 1912786567
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Entity Type | Organization
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Legal Business Name | CONCEIVABLE FERTILITY AND WELLNESS, LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 7525 MITCHELL RD STE 315
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1958
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Country | US
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Telephone | 952-300-3016
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Fax | 952-353-9635
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Provider Business Mailing Address
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Address Line | 7525 MITCHELL RD STE 315
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-1958
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Country | US
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Telephone | 952-300-3016
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Fax | 952-353-9635
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | SUSAN GOEHL-MANOLIS
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Credential | APRN
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Telephone | 952-300-3016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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