Healthcare Provider Details

I. General information

NPI: 1164979175
Provider Name (Legal Business Name): SUZANNE LLAMADO RN PHN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 WESTWIND BLVD SUITE 101
SANTA ROSA CA
95403-9081
US

IV. Provider business mailing address

3725 WESTWIND BLVD SUITE 101
SANTA ROSA CA
95403-9081
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-5733
  • Fax: 707-565-5739
Mailing address:
  • Phone: 707-565-5733
  • Fax: 707-565-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: