Provider Demographics
NPI:1508898677
Name:RITTER, SUSAN PARRY (RN, APNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PARRY
Last Name:RITTER
Suffix:
Gender:F
Credentials:RN, APNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 W 132ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2553
Mailing Address - Country:US
Mailing Address - Phone:952-220-0250
Mailing Address - Fax:
Practice Address - Street 1:2450 26TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1245
Practice Address - Country:US
Practice Address - Phone:612-728-2455
Practice Address - Fax:612-728-2401
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI81970-030363LG0600X
MNR 95529-4363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN90521900Medicaid
MN90521900Medicaid
MN500002836Medicare ID - Type Unspecified