MEDICARE: SUELLEN ROSE STENHOUSE PA

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	363AM0700X	Medical Physician Assistant	PA12264	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA12264	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1568565489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUELLEN ROSE STENHOUSE PA

Provider Business Mailing Address
First Line	:	1231 PLUMAS ST
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3410
Country	:	US
Telephone Number	:	530-751-8454
Fax Number	:	530-751-8456

Provider Business Practice Location Address
First Line	:	1231 PLUMAS ST
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-3410
Country	:	US
Telephone Number	:	530-751-8454
Fax Number	:	530-751-8456

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	04/26/2010

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Directions to “ SUELLEN ROSE STENHOUSE PA” Practice Location

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