Healthcare Provider Details

I. General information

NPI: 1013926435
Provider Name (Legal Business Name): SUSANNAH S. EWING MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANNAH STANLEY

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 SUTTER ST FL 6
SAN FRANCISCO CA
94115-3006
US

IV. Provider business mailing address

1635 DIVISADERO ST SUITE 625, BOX 1821
SAN FRANCISCO CA
94143-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2170
  • Fax: 415-353-9551
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number13717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: