Provider Demographics
NPI:1215907803
Name:LAVELL, SUSAN J (APRN, DNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:LAVELL
Suffix:
Gender:F
Credentials:APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6714 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2554
Mailing Address - Country:US
Mailing Address - Phone:612-861-8136
Mailing Address - Fax:
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1171970363LW0102X
MN2045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5K123LAOtherBCBS MN
HP18165OtherHEALTH PARTNERS
1017714OtherPREFERRED ONE
MN904718200Medicaid
111465OtherUCARE
07-00900OtherMEDICA
1069672OtherAMERICA'S PPO (ARAZ)
21274OtherSIOUX VALLEY HEALTH PLAN
111465OtherUCARE
21274OtherSIOUX VALLEY HEALTH PLAN