MEDICARE: SUSAN J LAVELL APRN, DNP

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	363LW0102X	Women's Health Nurse Practitioner	R1171970	MN
2	363LF0000X	Family Nurse Practitioner	2045	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5K123LA	OTHER	MN	BCBS MN
2	HP18165	OTHER		HEALTH PARTNERS
3	1017714	OTHER		PREFERRED ONE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	111465	OTHER		UCARE
6	07-00900	OTHER		MEDICA
7	1069672	OTHER		AMERICA'S PPO (ARAZ)
8	21274	OTHER		SIOUX VALLEY HEALTH PLAN

General Provider Information

NPI Number	:	1215907803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J LAVELL APRN, DNP

Provider Business Mailing Address
First Line	:	6714 OAKLAND AVE
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-2554
Country	:	US
Telephone Number	:	612-861-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 PHALEN BLVD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-5302
Country	:	US
Telephone Number	:	651-254-7870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	09/27/2023

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