Healthcare Provider Details

I. General information

NPI: 1497184162
Provider Name (Legal Business Name): SUSAN BENNETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 RAVENSHOE WAY
CHICO CA
95973-9138
US

IV. Provider business mailing address

1265 RAVENSHOE WAY
CHICO CA
95973-9138
US

V. Phone/Fax

Practice location:
  • Phone: 530-514-0046
  • Fax:
Mailing address:
  • Phone: 530-514-0046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number595900
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: