Provider Demographics
NPI:1558619221
Name:QUELLA, SUSAN K (RN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:QUELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1429
Mailing Address - Country:US
Mailing Address - Phone:612-338-5661
Mailing Address - Fax:888-216-9564
Practice Address - Street 1:2825 CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1429
Practice Address - Country:US
Practice Address - Phone:612-338-5661
Practice Address - Fax:888-216-9564
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR92417-3163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health