Provider Demographics
NPI:1508503525
Name:RICHTER, SUSANA E
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:E
Last Name:RICHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:ELIZABETH
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, CNP
Mailing Address - Street 1:210 9TH ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6400
Mailing Address - Country:US
Mailing Address - Phone:818-414-9836
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST SE STE 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6400
Practice Address - Country:US
Practice Address - Phone:507-288-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2459743363LP2300X
MN9635363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care