Healthcare Provider Details

I. General information

NPI: 1811908767
Provider Name (Legal Business Name): SUSAN ANN COOLIDGE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 POWER INN RD 190
SACRAMENTO CA
95826-3889
US

IV. Provider business mailing address

3331 POWER INN RD
SACRAMENTO CA
95826-3889
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-9864
  • Fax:
Mailing address:
  • Phone: 916-875-9864
  • Fax: 916-875-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number207107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: