Healthcare Provider Details

I. General information

NPI: 1386712412
Provider Name (Legal Business Name): SUSAN HOUSER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVE BUILDING 80, RM 239
SAN FRANCISCO CA
94110-2859
US

IV. Provider business mailing address

141 CRESCENT AVE
BURLINGAME CA
94010-5246
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8386
  • Fax: 415-206-6273
Mailing address:
  • Phone: 404-874-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberRN107872
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number723888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: