Healthcare Provider Details

I. General information

NPI: 1568440840
Provider Name (Legal Business Name): SUSAN MICHELLE FLAX-HEYER CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21217 NASHVILLE ST
CHATSWORTH CA
91311-1451
US

IV. Provider business mailing address

21217 NASHVILLE ST
CHATSWORTH CA
91311-1451
US

V. Phone/Fax

Practice location:
  • Phone: 818-349-3280
  • Fax: 818-349-3290
Mailing address:
  • Phone: 818-359-7075
  • Fax: 866-270-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number348033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: