Healthcare Provider Details

I. General information

NPI: 1679805592
Provider Name (Legal Business Name): SUSAN KYLEE NEWMAN RN, MSN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST, NURSING & WELLNESS ROOM 2121
SAN DIEGO CA
92103
US

IV. Provider business mailing address

4100 NORMAL STREET, ROOM 2121
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 619-725-5501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number17798
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number625461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: