Healthcare Provider Details

I. General information

NPI: 1154609949
Provider Name (Legal Business Name): SUSANNAH RACHAEL LABBE PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

IV. Provider business mailing address

1381 UNIVERSITY ST
HEALDSBURG CA
95448-3314
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax: 707-385-2157
Mailing address:
  • Phone: 707-433-5494
  • Fax: 707-385-2157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN590155
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP20881
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP20881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: