Healthcare Provider Details

I. General information

NPI: 1093734709
Provider Name (Legal Business Name): SUSAN HEALY ELDERS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11985 HERITAGE OAK PL SUITE 1
AUBURN CA
95603-2461
US

IV. Provider business mailing address

11985 HERITAGE OAK PL SUITE 1
AUBURN CA
95603-2461
US

V. Phone/Fax

Practice location:
  • Phone: 530-886-1387
  • Fax: 530-886-1334
Mailing address:
  • Phone: 530-886-1387
  • Fax: 530-886-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number236698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: