Individual
SUSAN J HALLORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1619 DAYTON AVE, #109, SAINT PAUL, MN 55104-6206
(651) 698-0891
Mailing address
1619 DAYTON AVE, #109, SAINT PAUL, MN 55104-6206
(651) 698-0891
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
R1075937
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
337140900
—
MN
Enumeration date
05/31/2006
Last updated
11/09/2016
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