Individual
SUZANNE S RUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
5200 FAIRVIEW BOULEVARD, FAIRVIEW LAKES PEDIATRICS, WYOMING, MN 55092
(651) 682-7340
(651) 982-7349
Mailing address
PO BOX 9372, FAIRVIEW HEALTH SERVICES, MINNEAPOLIS, MN 55440-9372
(612) 672-2294
(612) 672-6041
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R-111703-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42088721
—
NM
Enumeration date
10/03/2006
Last updated
12/26/2014
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