Provider Demographics
NPI:1548700677
Name:APOLLO, SUSAN NDUTA
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:NDUTA
Last Name:APOLLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:NDUTA
Other - Last Name:WAWERU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2316 LONDIN CT E # 28
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5517
Mailing Address - Country:US
Mailing Address - Phone:650-500-9820
Mailing Address - Fax:
Practice Address - Street 1:2316 LONDIN CT E # 28
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-5517
Practice Address - Country:US
Practice Address - Phone:651-500-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-200478-7163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health