Basic Information
| Provider Information | |||||||||
| NPI: | 1013908383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUSKA | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | APRN CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 CENTRACARE CIRCLE #2300 | ||||||||
| Address2: | CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMENS HE | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543630 | ||||||||
| FaxNumber: | 3206543657 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 CENTRACARE CIRCLE #2300 | ||||||||
| Address2: | CENTRACARE CLINIC HEALTH PLAZA OBSTETRICS AND WOMENS HE | ||||||||
| City: | ST CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563035000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206543630 | ||||||||
| FaxNumber: | 3206543657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | R1172555 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 363LW0102X | CNP0965 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 55G91SU | 01 | BLUE CROSS BLUE SHIELD | OTHER | 0702328 | 01 | MEDICA HEALTH PLANS | OTHER | 1531298 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | COMP | 01 | CHAMPUS | OTHER | COMP | 01 | FIRST HEALTH PLAN | OTHER | COMP | 01 | MMSI | OTHER | 1029789 | 01 | PREFERRED ONE | OTHER | 141210 | 01 | U CARE | OTHER | HP34917 | 01 | HEALTH PARTNERS | OTHER | COMP | 01 | ONE HEALTH PLAN GREAT WES | OTHER |