Provider Demographics
NPI:1790767929
Name:PIEHL, SUSAN M (CNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PIEHL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 106606 9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
142936OtherU CARE
0407023OtherMEDICA HEALTH PLANS
08 16 04OtherFIRST HEALTH PLAN
8 16 04OtherGREAT WEST
1032239OtherPREFERRED ONE
1714241OtherAMERICAS PPO
8 16 04OtherONE HEALTH PLAN
8 23 04OtherCHAMPUS
HP36993OtherHEALTH PARTNERS
1714241OtherARAZ GROUP
P00147349OtherRR MEDICARE
6D053CEOtherBLUE CROSS BLUE SHIELD
313K9PIOtherBLUE CROSS BLUE SHIELD
142936OtherU CARE
8 16 04OtherGREAT WEST