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Susanne L Riedel

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

2901 W Kinnickinnic River Pkwy Ste 507, Milwaukee, WI 53215-3660

PECOS Enrollment

This provider is enrolled in PECOS as SUSANNE RIEDEL.

Based on the most recent information from CMS, provider Susanne L Riedel is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1598014359
Provider Type
Individual
Full Name
Riedel, Susanne L
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
9/7/2012
Last Updated
12/10/2023

Contact Information

Practice Location

2901 W Kinnickinnic River Pkwy Ste 507, Milwaukee, WI 53215-3660

(414) 649-3780

Unlisted Fax

Mailing Location

PO Box 735044, Chicago, IL 60673-5044

(822) 326-2250

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 4995 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 100024982	Description Medicaid	Issuer Unlisted Wisconsin

Susanne L Riedel

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Mcginn, Melodie L

Lesniewski, Jennifer A

Cherba, Nanette

Fisher, Rachel M

Ozzello, Allysa

Muzi, Mary Ann

Keller, Mary Margaret

Eilers, Sarah

Freeland, Kathleen A

Christian, Jordan Jean