Provider Demographics
NPI:1720057193
Name:AHLNESS, SUSAN M (APRN, BC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:AHLNESS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MICHELLE
Other - Last Name:LOCHNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 4TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1109
Mailing Address - Country:US
Mailing Address - Phone:507-794-8447
Mailing Address - Fax:507-794-5950
Practice Address - Street 1:400 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1109
Practice Address - Country:US
Practice Address - Phone:507-794-3691
Practice Address - Fax:507-794-5950
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN038224622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
0116725OtherMEDICA
MR9121040444OtherPREFERRED ONE
MN105143100Medicaid
210K9AHOtherMPIN
P00098870OtherMEDICARE RAILROAD
131363OtherUCARE
7746556OtherAETNA
210K9AHOtherMPIN
MN105143100Medicaid