Provider Demographics
NPI:1154092138
Name:NORGARD, MARY SUSAN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:NORGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 W 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:TRUMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56088-1225
Mailing Address - Country:US
Mailing Address - Phone:651-285-1766
Mailing Address - Fax:
Practice Address - Street 1:1703 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5447
Practice Address - Country:US
Practice Address - Phone:507-345-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1718825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse