Individual
SUSAN GROSSE-MACEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
153 CESAR CHAVEZ ST, W. ST. PAUL, MN 55107-2226
(651) 222-1816
(651) 222-2226
Mailing address
153 CESAR CHAVEZ ST, W. ST. PAUL, MN 55107-2226
(651) 222-1816
(651) 222-2226
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1451
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0102292
MEDICA
MN
01
—
108562
UCARE
MN
05
—
153842000
—
MN
01
—
53M29GR
BCBS
MN
01
—
923911025971
PREFERRED ONE
MN
01
—
HP26519
HEALTH PARTNERS
MN
Enumeration date
04/04/2006
Last updated
05/23/2019
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