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General NPI Number Information
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NPI Number | 1689740722
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Entity Type | Individual
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Provider Name | SUSAN HILLARY MYKITA RN, NP
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/26/2007
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Provider Practice Location Address
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Address Line | 4700 COLLEGE OAK DR AMERICAN RIVER COLLEGE
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City | SACRAMENTO
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State | CA
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Zip | 95841-4217
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Country | US
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Telephone | 916-484-8383
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Fax | 916-484-8759
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Provider Business Mailing Address
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Address Line | 1691 THE ALAMEDA
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City | SAN JOSE
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State | CA
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Zip | 95126-2203
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Country | US
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Telephone | 408-287-7532
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Fax | 408-287-0405
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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 | 163WC1400X
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Taxonomy Name | College Health Registered Nurse
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License Number | RN293133
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | NP7781
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License Number State | CA
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