Provider Demographics
NPI:1952469017
Name:SUFFRINS, PELAGIE TARA (CNP)
Entity Type:Individual
Prefix:
First Name:PELAGIE
Middle Name:TARA
Last Name:SUFFRINS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:PELAGIE
Other - Middle Name:TARA
Other - Last Name:SNESRUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 9TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-6756
Mailing Address - Country:US
Mailing Address - Phone:507-288-3443
Mailing Address - Fax:
Practice Address - Street 1:210 9TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-6756
Practice Address - Country:US
Practice Address - Phone:507-288-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000487363LW0102X
MNR1382989363LW0102X
MN3035363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR035692OtherRN LICENSE
SDCP000487OtherCNP LICENSE