Provider Demographics
NPI:1396404919
Name:BRONNER, SUSAN KAY
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:BRONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W WINONA AVE
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:MN
Mailing Address - Zip Code:55945-8856
Mailing Address - Country:US
Mailing Address - Phone:507-676-2039
Mailing Address - Fax:
Practice Address - Street 1:315 W WINONA AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:MN
Practice Address - Zip Code:55945-8856
Practice Address - Country:US
Practice Address - Phone:507-676-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2244000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse