Provider Demographics
NPI:1568634210
Name:KEUSEMAN, SUZANNE MARIE (APRN, CNS-BC, CWOCN)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARIE
Last Name:KEUSEMAN
Suffix:
Gender:F
Credentials:APRN, CNS-BC, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BECKER AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3302
Mailing Address - Country:US
Mailing Address - Phone:320-231-4142
Mailing Address - Fax:320-231-4092
Practice Address - Street 1:301 BECKER AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3302
Practice Address - Country:US
Practice Address - Phone:320-231-4142
Practice Address - Fax:320-231-4092
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-081413-1163W00000X
MN0368715-18163WC1500X
MN12453163WG0600X
MN2005454359163WC2100X, 163WX1500X, 163WW0000X
MNCNS 0078364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1568634210Medicaid
MN890000421Medicare UPIN