Provider Demographics
NPI:1497855860
Name:MORRIS, SUSAN DIANE (RN CFNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DIANE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:RN CFNP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:MORRIS
Other - Last Name:ELWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:324 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4412
Mailing Address - Country:US
Mailing Address - Phone:651-587-9959
Mailing Address - Fax:
Practice Address - Street 1:7200 VALLEY CREEK PLAZA
Practice Address - Street 2:TARGET CLINIC WOODBURY
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-735-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1233083363L00000X
MN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S89774Medicare UPIN