MEDICARE: SUE ANN HADLEY APRN

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
1	363L00000X	Nurse Practitioner	386264	CA

General Provider Information

NPI Number	:	1275733115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN HADLEY APRN

Provider Business Mailing Address
First Line	:	3014 OLD BRIDGEPORT WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7734
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 CAMPANILE DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92182-0001
Country	:	US
Telephone Number	:	619-594-2770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	07/19/2007

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