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NPI Code Detail

MEDICARE: MS. SUSAN PATRICIA MCKEEFREY M.N., A.R.N.P.

MEDICARE: MS. SUSAN PATRICIA MCKEEFREY M.N., A.R.N.P.
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
1363LP2300XPrimary Care Nurse PractitionerAP-30001938WA
2363LF0000XFamily Nurse PractitionerNP21794CA

General Provider Information

NPI Number : 1194703843
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN PATRICIA MCKEEFREY M.N., A.R.N.P.
Provider Business Mailing Address
First Line : 1691 THE ALAMEDA
Second Line :
City : SAN JOSE
State : CA
Zip : 95126-2203
Country : US
Telephone Number : 408-795-3600
Fax Number : 408-287-0405
Provider Business Practice Location Address
First Line : 650 N FULTON ST
Second Line :
City : FRESNO
State : CA
Zip : 93728-3404
Country : US
Telephone Number : 559-488-4900
Fax Number : 559-488-4999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 12/12/2012

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