Healthcare Provider Details

I. General information

NPI: 1295329977
Provider Name (Legal Business Name): LOUISA SUSHANSKY RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1838 EL CAMINO REAL STE 100
BURLINGAME CA
94010-3105
US

IV. Provider business mailing address

1838 EL CAMINO REAL STE 100
BURLINGAME CA
94010-3105
US

V. Phone/Fax

Practice location:
  • Phone: 415-828-3805
  • Fax:
Mailing address:
  • Phone: 415-287-0859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number95192627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: