Healthcare Provider Details

I. General information

NPI: 1407172950
Provider Name (Legal Business Name): SUSAN JENNIFER KEIPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. SUSAN JENNIFER HARUFF

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST C3C162
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1200 N STATE ST INPATIENT TOWER C3C162
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-3094
  • Fax: 323-441-8390
Mailing address:
  • Phone: 323-409-3094
  • Fax: 323-441-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN313800
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: