Provider Demographics
NPI:1972540573
Name:MURRAY, SUSAN A (PA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:MURRAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3417
Mailing Address - Country:US
Mailing Address - Phone:651-747-7397
Mailing Address - Fax:
Practice Address - Street 1:1687 WOODLANE DR STE 103
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3046
Practice Address - Country:US
Practice Address - Phone:651-578-1000
Practice Address - Fax:651-578-0056
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S85951Medicare UPIN