Provider Demographics
NPI:1174745715
Name:KARNITZ, SUSAN M (CNS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:KARNITZ
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:9289 JERGEN AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016
Mailing Address - Country:US
Mailing Address - Phone:651-326-7628
Mailing Address - Fax:651-232-7240
Practice Address - Street 1:1575 BEAM AVENUE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109
Practice Address - Country:US
Practice Address - Phone:651-326-7628
Practice Address - Fax:651-232-7240
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR153383-5364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist