Healthcare Provider Details

I. General information

NPI: 1679684906
Provider Name (Legal Business Name): SUSAN DENISE BAER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HOMESTEAD RD CDRP, 1ST FLOOR
CUPERTINO CA
95014-0712
US

IV. Provider business mailing address

19000 HOMESTEAD RD CDRP, 1ST FLOOR
CUPERTINO CA
95014-0712
US

V. Phone/Fax

Practice location:
  • Phone: 408-366-4200
  • Fax:
Mailing address:
  • Phone: 408-366-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number492005
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: