Provider Demographics
NPI:1467446062
Name:WHIRLEY, SUSANNE MARIA (MSN)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:MARIA
Last Name:WHIRLEY
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEERWOOD AVE NW
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1253
Mailing Address - Country:US
Mailing Address - Phone:218-631-1360
Mailing Address - Fax:218-631-7571
Practice Address - Street 1:4 DEERWOOD AVE NW
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1253
Practice Address - Country:US
Practice Address - Phone:218-631-1360
Practice Address - Fax:218-631-7571
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0798707363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN776170800Medicaid
Q44653Medicare UPIN
0275230001Medicare NSC
500003398Medicare PIN
MN776170800Medicaid