Provider Demographics
NPI:1740244599
Name:ENGESETH, SUSAN C (CNS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:ENGESETH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 FISH HATCHERY RD
Mailing Address - Street 2:DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1911
Mailing Address - Country:US
Mailing Address - Phone:608-252-8000
Mailing Address - Fax:608-252-8245
Practice Address - Street 1:1313 FISH HATCHERY RD
Practice Address - Street 2:DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1911
Practice Address - Country:US
Practice Address - Phone:608-252-8000
Practice Address - Fax:608-252-8245
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1840-033133N00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1540OtherDEAN HEALTH INSURANCE
WI43881000Medicaid
P20299Medicare UPIN
WI890001100Medicare PIN
WI064474150Medicare PIN