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General NPI Number Information
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NPI Number | 1174619787
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Entity Type | Individual
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Provider Name | SUSAN JANE RIESEL WHPAC
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 770 10TH STREET
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City | ARCATA
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State | CA
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Zip | 95521
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Country | US
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Telephone | 707-826-8610
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Fax | 707-826-8623
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Provider Business Mailing Address
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Address Line | 670 NINTH STREET SUITE 203
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City | ARCATA
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State | CA
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Zip | 95521
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Country | US
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Telephone | 707-826-8633
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Fax | 707-826-8638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA50880
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License Number State | CA
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