Provider Demographics
NPI:1164307070
Name:GARTNER, SUZANNE RENAE
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RENAE
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 1:4517 IMPALA CT NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1053
Mailing Address - Country:US
Mailing Address - Phone:701-400-9279
Mailing Address - Fax:
Practice Address - Street 1:702 E ASH AVE APT 118
Practice Address - Street 2:
Practice Address - City:GLEN ULLIN
Practice Address - State:ND
Practice Address - Zip Code:58631-7162
Practice Address - Country:US
Practice Address - Phone:701-348-9232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide