Provider Demographics
NPI:1528037447
Name:MCINTYRE, SUSAN J (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS: 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1449
Practice Address - Country:US
Practice Address - Phone:715-243-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3315363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN16A22MCOtherBLUE CROSS BLUE SHIELD MN
MN239823100Medicaid
MN1010196OtherPREFERREDONE
MN1552595OtherAMERICA'S PPO
WI43940000Medicaid
MN0401004OtherMEDICA
MNHP32938OtherHEALTHPARTNERS
MN151526OtherUCARE MN
MN500002270Medicare ID - Type UnspecifiedMN MEDICARE
WI43940000Medicaid
MNP31615Medicare UPIN