Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 56125 | MN |
NPI | 1003134677 |
---|---|
Provider Name | Dr. Bridgette Marie Suri |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Woodbury, MN 55125-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 16/04/2019 |