Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | CNP 5086 | MN |
NPI | 1013291434 |
---|---|
Provider Name | Ms. Suzanne Elizabeth Shane |
First Address | Minneapolis, MN 55455-0341 |
Second Address | Minneapolis, MN 55455-0363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2011 |
Last Update Date | 29/04/2017 |