Healthcare Provider Details

I. General information

NPI: 1417626151
Provider Name (Legal Business Name): SUSAN EYMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 MILLIKEN AVE STE 110
RANCHO CUCAMONGA CA
91730-7442
US

IV. Provider business mailing address

11660 CHURCH ST
RANCHO CUCAMONGA CA
91730-8917
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-8011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number779892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: