Provider Demographics
NPI:1275613853
Name:NELSON, SUSAN WOLF (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WOLF
Last Name:NELSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 42ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5310
Mailing Address - Country:US
Mailing Address - Phone:701-235-8790
Mailing Address - Fax:
Practice Address - Street 1:301 NP AVENUE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4820
Practice Address - Country:US
Practice Address - Phone:701-271-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist