Provider Demographics
NPI:1336121847
Name:FIX, SUSAN KAY (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:FIX
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12200 MIDDLE SET RD
Mailing Address - Street 2:100
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5415
Mailing Address - Country:US
Mailing Address - Phone:952-943-8200
Mailing Address - Fax:952-943-8206
Practice Address - Street 1:12200 MIDDLE SET RD
Practice Address - Street 2:100
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5415
Practice Address - Country:US
Practice Address - Phone:952-943-8200
Practice Address - Fax:952-943-8206
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR113505-5363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNPP003Medicare UPIN