Provider Demographics
NPI:1811917594
Name:FORSYTHE, SUZANNE KAY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:KAY
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43150 SHENANDOAH LOOP
Mailing Address - Street 2:
Mailing Address - City:DENT
Mailing Address - State:MN
Mailing Address - Zip Code:56528-9046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1821 N PARK ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1247
Practice Address - Country:US
Practice Address - Phone:218-739-1400
Practice Address - Fax:218-739-1401
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR069132-5363LF0000X
NDR14864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN