Individual
SUSAN LEE KISSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CNP
Contact information
Practice address
401 CARLSON PARKWAY, MINNETONKA, MN 55305-5387
(952) 992-3612
Mailing address
5510 MOUNT NORMANDALE CURV, BLOOMINGTON, MN 55437-1022
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
R0665283
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1145878-00
—
MN
Enumeration date
08/07/2006
Last updated
09/02/2011
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