| Doctor Name: | DR. SUSAN KRISTA RUTTEN WASSON |
| NPI Number: | 1417920190 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 200 Nokomis St. Osakis, MN - 563604920 |
| Business Phone Number: | 3208592366 |
| Business Fax Number: | 3208595234 |
| Mailing Address: | 200 Nokomis St., P. O. Box 358 OSAKIS |
| State: | MN |
| Postal Code: | 563604920 |
| Phone Number: | 3208592366 |
| Fax Number: | 3208595234 |
| NPI Enumeration Date: | 02/10/2006 |
| NPI Last Update Date: | 01/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |