Susan Ann Demeulenaere, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704190745 Issued in MI

Practice address

920 2ND Ave S
Suite 400
Minneapolis, MN 55402-3318

Phone

(612) 225-1512

NPI assigned

Oct 9, 2005

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 names 1

• Susan Ann Mozdzen Former name

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 and National Provider Directory roles.

• Vpa PC

  • Family Medicine Physician
  • Troy, MI
  • NPI 1336153295
  NPD (past)
• Vpa PC

  • Family Medicine Physician
  • Brentwood, TN
  • NPI 1578363362
  NPD (past)

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

{
    "created_epoch": "1128816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453248000000",
    "number": "1689662272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "address_2": "SUITE 400",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-985-1819",
            "fax_number": "810-984-1160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 2ND AVE S",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554023318",
            "telephone_number": "612-225-1512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMEULENAERE",
        "first_name": "SUSAN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-09",
        "last_updated": "2016-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704190745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "MOZDZEN",
            "middle_name": "ANN",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marielle Kathleen Divilbiss Demarais, PHD, LP
• Dagim Teshome Demeke
• Alexandra Demello
• Joseph Anthony Demello, MD
• Lauren Demet, L.AC
• Martha Demeules, MD
• Joanna Demkiewicz
• Haley Deml, CPHT
• Margaret(Peg) Anne Demmer, RN, CCRC
• George Elias Demonakos, DDS

• Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.