Healthcare Provider Details

I. General information

NPI: 1821070012
Provider Name (Legal Business Name): SUSAN HELEN AMENT RN MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY AVE
HEALDSBURG CA
95448-3314
US

IV. Provider business mailing address

1381 UNIVERSITY AVE
HEALDSBURG CA
95448-3314
US

V. Phone/Fax

Practice location:
  • Phone: 707-431-8234
  • Fax: 707-431-1427
Mailing address:
  • Phone: 707-431-8234
  • Fax: 707-431-1427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN407066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: