Susan J Halloran, NP

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

R1075937 Issued in MN

Practice address

1619 Dayton Ave
#109
Saint Paul, MN 55104-6206

Phone

(651) 698-0891

NPI assigned

May 31, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Menopause Center of Minnesota

  • Gynecology Physician
  • Saint Paul, MN
  • NPI 1417127903
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1093752230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 DAYTON AVE",
            "address_2": "#109",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046206",
            "telephone_number": "651-698-0891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 DAYTON AVE",
            "address_2": "#109",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551046206",
            "telephone_number": "651-698-0891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLORAN",
        "first_name": "SUSAN",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-31",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "MN",
            "license": "R1075937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337140900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shandon Halland, RN, CNP
• Glenn Haller, MD
• Paul R Haller, MD
• Mark Christopher Halley, PSY.D.
• Victoria Elizabeth Hallgren, MS-CLINMENHLTHCOUN
• Andrew Halverson, MDT
• John Halvorsen, MD
• Tanya L. Halvorsen, M.D.
• Paige Josephine Halvorson, M.D.
• Julie C Haman, DDS

• Obstetrics & Gynecology Nurse Practitioner in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Obstetrics & Gynecology Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.