Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R 110333-3 | MN |
NPI | 1154600740 |
---|---|
Provider Name | Susan Marie Pfister |
First Address | Robbinsdale, MN 55422-2926 |
Second Address | Robbinsdale, MN 55422-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2011 |
Last Update Date | 06/08/2012 |