=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831113075
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN J REES RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9261 FOLSOM BLVD SUITE 300
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95826-2561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-854-4552
-----------------------------------------------------
Fax | 916-854-4556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 Q ST APT. # 323
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95814-6653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-505-7099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | 675038
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------