Provider Demographics
NPI:1265535876
Name:BUELOW, SUSAN MARIE (RN CNS)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:BUELOW
Suffix:
Gender:F
Credentials:RN CNS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6331 TAHOE PL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1470
Mailing Address - Country:US
Mailing Address - Phone:612-562-0984
Mailing Address - Fax:
Practice Address - Street 1:659 BIELENBERG DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1706
Practice Address - Country:US
Practice Address - Phone:651-259-9710
Practice Address - Fax:651-259-9780
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR12983032084P0800X
NDR289002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN894638800Medicaid
S89777Medicare UPIN
MN894638800Medicaid