Provider Demographics
NPI:1013908383
Name:SUSKA, JANE MARIE (APRN CNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:SUSKA
Suffix:
Gender:F
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE #2300
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMENS HE
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIRCLE #2300
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMENS HE
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1172555363LW0102X
MNCNP0965363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
55G91SUOtherBLUE CROSS BLUE SHIELD
0702328OtherMEDICA HEALTH PLANS
1531298OtherARAZ GROUP AMERICAS PPO
COMPOtherCHAMPUS
COMPOtherFIRST HEALTH PLAN
COMPOtherMMSI
1029789OtherPREFERRED ONE
141210OtherU CARE
HP34917OtherHEALTH PARTNERS
COMPOtherONE HEALTH PLAN GREAT WES
COMPOtherMMSI
P49964Medicare UPIN