Provider Demographics
NPI:1023778370
Name:GARTNER, SUSAN MARLENE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARLENE
Last Name:GARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 100TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-8203
Mailing Address - Country:US
Mailing Address - Phone:701-871-2248
Mailing Address - Fax:
Practice Address - Street 1:1241 100TH ST NE
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-8203
Practice Address - Country:US
Practice Address - Phone:701-871-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider