| Doctor Name: | TRACY SUZANNE COUSIN |
| NPI Number: | 1003891144 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | R1602591 |
| Business Practice Address: | 1200 6th Avenue N St Cloud, MN - 56303 |
| Business Phone Number: | 3202525131 |
| Business Fax Number: | 3202402118 |
| Mailing Address: | 1200 6th Avenue N, ST CLOUD |
| State: | MN |
| Postal Code: | 56303 |
| Phone Number: | 3202525131 |
| Fax Number: | 3202402118 |
| NPI Enumeration Date: | 12/13/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | R1602591 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |