Provider Demographics
NPI:1447260088
Name:JELENSE, SUZANNE M (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:JELENSE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:859 MANKATO AVENUE
Mailing Address - Street 2:WINONA CLINIC LTD
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987
Mailing Address - Country:US
Mailing Address - Phone:507-454-3680
Mailing Address - Fax:507-457-7672
Practice Address - Street 1:859 MANKATO AVENUE
Practice Address - Street 2:WINONA CLINIC LTD
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987
Practice Address - Country:US
Practice Address - Phone:507-454-3680
Practice Address - Fax:507-457-7672
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN20569208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93307Medicare UPIN