Provider Demographics
NPI:1376694992
Name:FLETCHER, SUZANNE R (RN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:R
Other - Last Name:NESLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:10005 RUSSELL AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3793
Practice Address - Country:US
Practice Address - Phone:612-596-0841
Practice Address - Fax:612-879-3823
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129776-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
00OtherNO OTHER NUMBERS ASSIGNED