Provider Demographics
NPI:1083988489
Name:HARRIS, SUSAN CAROL (FNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 MINNESOTA ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2269
Mailing Address - Country:US
Mailing Address - Phone:651-334-4360
Mailing Address - Fax:320-358-2087
Practice Address - Street 1:445 MINNESOTA ST STE 1500
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2269
Practice Address - Country:US
Practice Address - Phone:651-334-4360
Practice Address - Fax:320-358-2087
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF0212354363LF0000X
AZAP11239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily