Provider Demographics
NPI:1699848200
Name:FISHMAN, SUSAN ANN (BSN, RN, CWOCN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANN
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:BSN, RN, CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4109
Mailing Address - Country:US
Mailing Address - Phone:651-688-8179
Mailing Address - Fax:651-688-8179
Practice Address - Street 1:7060 SPRINGHILL CIR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55346-2615
Practice Address - Country:US
Practice Address - Phone:952-993-9632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR088948-3163WX1500X, 163WW0000X, 163WC2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
Not Answered163WW0000XNursing Service ProvidersRegistered NurseWound Care
Not Answered163WC2100XNursing Service ProvidersRegistered NurseContinence Care