Provider Demographics
NPI:1275709222
Name:LEE, SUZANNE M (DNP)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3361 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2624
Mailing Address - Country:US
Mailing Address - Phone:763-427-1950
Mailing Address - Fax:764-427-7006
Practice Address - Street 1:3361 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2624
Practice Address - Country:US
Practice Address - Phone:763-427-1950
Practice Address - Fax:763-427-7006
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 062497-8364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1275709222Medicaid
MN1275709222Medicaid