Healthcare Provider Details

I. General information

NPI: 1700951621
Provider Name (Legal Business Name): SUSANNE ISABEL KILLING APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VAN NESS AVENUE
SAN FRANCISCO CA
94102
US

IV. Provider business mailing address

1131 CHAUCER ST
BERKELEY CA
94702-2032
US

V. Phone/Fax

Practice location:
  • Phone: 415-558-5900
  • Fax: 415-558-5959
Mailing address:
  • Phone: 415-558-5900
  • Fax: 415-558-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 557976
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPF12780
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberCNS 1531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: