Provider Demographics
NPI:1932384310
Name:MAHON, SUSAN MARGARET (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARGARET
Last Name:MAHON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MARGARET
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4162 LITTLE BOY RD NE
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56655
Mailing Address - Country:US
Mailing Address - Phone:218-363-3646
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1632998163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse