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NPI Code Detail

MEDICARE: SUELLEN S ESCHENBACH RN, NP

MEDICARE: SUELLEN S ESCHENBACH RN, NP
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
1163W00000XRegistered Nurse255252CA
2363L00000XNurse Practitioner11666CA

General Provider Information

NPI Number : 1255414009
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUELLEN S ESCHENBACH RN, NP
Provider Business Mailing Address
First Line : 751 LOMBARDI CT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-6798
Country : US
Telephone Number : 707-547-2222
Fax Number : 707-547-2229
Provider Business Practice Location Address
First Line : 751 LOMBARDI CT
Second Line :
City : SANTA ROSA
State : CA
Zip : 95407-6798
Country : US
Telephone Number : 707-547-2222
Fax Number : 707-547-2229
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 10/13/2011

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