| Doctor Name: | MRS. MARY SUSAN CLIPP |
| NPI Number: | 1003150194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP-AC |
| License Number: | 2036438 |
| Business Practice Address: | 2450 Riverside Ave Minneapolis, MN - 554541450 |
| Business Phone Number: | 6123653100 |
| Business Fax Number: | 6123653110 |
| Mailing Address: | 3333 Harriet Ave, MINNEAPOLIS |
| State: | MN |
| Postal Code: | 554083729 |
| Phone Number: | 7735124511 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0222X |
| License Number: | 2036438 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics, Critical Care |
| Taxonomy Definition: | |