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NPI Code Detail

MEDICARE: SUSAN J DEAN

MEDICARE: SUSAN J DEAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerFNP15341CA

General Provider Information

NPI Number : 1093913881
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN J DEAN
Provider Business Mailing Address
First Line : 548 WILLARD AVE
Second Line :
City : BRAWLEY
State : CA
Zip : 92227-3049
Country : US
Telephone Number : 760-344-3338
Fax Number :
Provider Business Practice Location Address
First Line : 450 E BIRCH ST
Second Line :
City : CALEXICO
State : CA
Zip : 92231-2375
Country : US
Telephone Number : 760-768-6262
Fax Number : 760-768-6290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2007
Last Update Date : 05/11/2018

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Directions to “ SUSAN J DEAN ” Practice Location

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