Provider Demographics
NPI:1255377404
Name:HARMAN, SUSAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:HARMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1430 NORTH HWY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1093
Practice Address - Country:US
Practice Address - Phone:507-847-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
228693OtherMIDLANDS CHOICE
6279OtherAVERA HEALTH PLANS
IA71091OtherWELLMARK BS
IA228693OtherMIDLANDS CHOICE
20540OtherSANFORD HEALTH PLANS
IAP00605698OtherRAILROAD MEDICARE PTAN
20540OtherSANFORD HEALTH PLANS
6279OtherAVERA HEALTH PLANS