Provider Demographics
NPI:1437442498
Name:ZANDER, SUZANNE ALICE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ALICE
Last Name:ZANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:ZANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:840 MALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:MN
Mailing Address - Zip Code:55395-6573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:840 MALLARD AVE
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:MN
Practice Address - Zip Code:55395-6573
Practice Address - Country:US
Practice Address - Phone:612-978-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR190565-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse