Provider Demographics
NPI:1275538886
Name:GOODLAXSON LANDGREBE, SUSANNE JANINE (ARNP, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:JANINE
Last Name:GOODLAXSON LANDGREBE
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:IA
Mailing Address - Zip Code:50054
Mailing Address - Country:US
Mailing Address - Phone:515-674-4186
Mailing Address - Fax:515-674-4180
Practice Address - Street 1:106 N. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:IA
Practice Address - Zip Code:50054
Practice Address - Country:US
Practice Address - Phone:515-674-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-093590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77496Medicare UPIN