Provider Demographics
NPI:1841723285
Name:MEYER, SUSAN AMME (BSN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:AMME
Last Name:MEYER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 34TH AVE S
Mailing Address - Street 2:APT 203
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2164
Mailing Address - Country:US
Mailing Address - Phone:651-431-8024
Mailing Address - Fax:
Practice Address - Street 1:5450 34TH AVE S
Practice Address - Street 2:APT 203
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2164
Practice Address - Country:US
Practice Address - Phone:651-431-8024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1405387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse