Individual
SUSAN QUEEN DJAVEDAN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4100 UPTON AVE N, MINNEAPOLIS, MN 55412-1522
(702) 506-2305
Mailing address
4100 UPTON AVE NO., MINNEAPOLIS, MN 55412
(702) 506-2305
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
L045270-0
MN
207QA0505X
Adult Medicine Physician
L045270-0
MN
Other
Enumeration date
12/22/2008
Last updated
12/22/2008
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