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NPI Code Detail

MEDICARE: SUSAN PERKINS VANSTEENKISTE R.N.

MEDICARE: SUSAN PERKINS VANSTEENKISTE R.N.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner517020CA

General Provider Information

NPI Number : 1356566251
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN PERKINS VANSTEENKISTE R.N.
Provider Business Mailing Address
First Line : 17284 DOG BAR RD
Second Line :
City : GRASS VALLEY
State : CA
Zip : 95949-9511
Country : US
Telephone Number : 530-889-7169
Fax Number : 530-889-7198
Provider Business Practice Location Address
First Line : 11484 B AVE
Second Line :
City : AUBURN
State : CA
Zip : 95603-2603
Country : US
Telephone Number : 530-889-7169
Fax Number : 530-889-7198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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