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NPI Code Detail

MEDICARE: MS. SUSAN LIGHT R.N.N.P.

MEDICARE: MS. SUSAN LIGHT R.N.N.P.
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
1363L00000XNurse Practitioner286198CA

General Provider Information

NPI Number : 1619077278
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN LIGHT R.N.N.P.
Provider Business Mailing Address
First Line : 116 ARLENE DR
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94595-1731
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : UNIVERSITY OF CALIFORNIA 2222BANCROFT WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94720-0001
Country : US
Telephone Number : 510-643-7109
Fax Number : 510-643-2997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2006
Last Update Date : 07/08/2007

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