Provider Demographics
NPI:1629201751
Name:GOEHL-MANOLIS, SUSAN ROLLER (APRN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROLLER
Last Name:GOEHL-MANOLIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:GOEHL
Other - Last Name:HEMME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8941 AZTEC DR STE A
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1916
Mailing Address - Country:US
Mailing Address - Phone:952-300-3016
Mailing Address - Fax:952-353-9635
Practice Address - Street 1:8941 AZTEC DR STE A
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1916
Practice Address - Country:US
Practice Address - Phone:952-300-3016
Practice Address - Fax:952-353-9635
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNP1196272363LW0102X
MN1428363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology