Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | COANP04616 | OH |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 7041 | MN |
N | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.04616 | OH |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | SUS104286507 | OH |
NPI | 1285800631 |
---|---|
Provider Name | Ms. Lori Jean Sussman |
First Address | Minneapolis, MN 55407-3723 |
Second Address | Minneapolis, MN 55407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 29/10/2019 |