Provider Demographics
NPI:1255583449
Name:TRUNNELL, SUZANNE ELIZABETH
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:TRUNNELL
Suffix:
Gender:F
Credentials:
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 43, MAIL ROUTE 10807
Mailing Address - Street 2:ASPEN MEDICAL GROUP--DIVISION OFFICE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-4828
Mailing Address - Fax:612-262-4191
Practice Address - Street 1:1020 BANDANA BLVD. W
Practice Address - Street 2:ASPEN MEDICAL GROUP--BANDANA SQUARE
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108
Practice Address - Country:US
Practice Address - Phone:651-641-7000
Practice Address - Fax:651-641-7166
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-165717-7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner