MEDICARE: ISUROON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144875097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISUROON

Provider Business Mailing Address
First Line	:	1600 E LAKE ST FL 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1884
Country	:	US
Telephone Number	:	612-889-2731
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E LAKE ST FL 1
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1884
Country	:	US
Telephone Number	:	612-889-2731
Fax Number	:

Authorized Official
Title or Position	:	SENIOR PROGRAM MANAGER
Name	:	ROBIN LEE WETZEL
Credential	:	PH.D.
Telephone Number	:	612-886-2731

Provider Enumeration Date	:	08/07/2019
Last Update Date	:	08/07/2019

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Directions to “ISUROON ” Practice Location

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