Provider Demographics
NPI:1982802450
Name:GREENQUIST, SUZANNE MINARICK (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MINARICK
Last Name:GREENQUIST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-1959
Mailing Address - Country:US
Mailing Address - Phone:402-304-1904
Mailing Address - Fax:
Practice Address - Street 1:960 E 54TH ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-1959
Practice Address - Country:US
Practice Address - Phone:402-304-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055301100Medicaid
NE47055301100Medicaid