MEDICARE: CONCEIVABLE FERTILITY AND WELLNESS, LLC

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

General Provider Information

NPI Number	:	1912786567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEIVABLE FERTILITY AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	7525 MITCHELL RD STE 315
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-1958
Country	:	US
Telephone Number	:	952-300-3016
Fax Number	:	952-353-9635

Provider Business Practice Location Address
First Line	:	7525 MITCHELL RD STE 315
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-1958
Country	:	US
Telephone Number	:	952-300-3016
Fax Number	:	952-353-9635

Authorized Official
Title or Position	:	NURSE PRACTITIONER/OWNER
Name	:	SUSAN GOEHL-MANOLIS
Credential	:	APRN
Telephone Number	:	952-300-3016

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	01/07/2026

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