Basic Information
Provider Information
NPI: 1083681472
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHINZEL
FirstName: SUZANNE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8100 34TH AVE S
Address2: 21110Q
City: BLOOMINGTON
State: MN
PostalCode: 554251672
CountryCode: US
TelephoneNumber: 9528835790
FaxNumber: 9528835395
Practice Location
Address1: 11475 ROBINSON DR NW
Address2:  
City: COON RAPIDS
State: MN
PostalCode: 554333746
CountryCode: US
TelephoneNumber: 7637126000
FaxNumber: 7637544614
Other Information
ProviderEnumerationDate: 03/03/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XR0958453MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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