Provider Demographics
NPI:1649308503
Name:MESTETH, SUZIE F (PHN)
Entity type:Individual
Prefix:
First Name:SUZIE
Middle Name:F
Last Name:MESTETH
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MINNI TOHE DR
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-4400
Mailing Address - Country:US
Mailing Address - Phone:701-627-4701
Mailing Address - Fax:
Practice Address - Street 1:1 MINNI TOHE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-4400
Practice Address - Country:US
Practice Address - Phone:701-627-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27578163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse