MEDICARE: MRS. SUSAN J. ROSTEN 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
1	363L00000X	Nurse Practitioner	10076	CA

General Provider Information

NPI Number	:	1659439602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN J. ROSTEN NP

Provider Business Mailing Address
First Line	:	1020 NUT TREE RD
Second Line	:	SUITE 290
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4100
Country	:	US
Telephone Number	:	707-624-8230
Fax Number	:	707-624-7998

Provider Business Practice Location Address
First Line	:	1020 NUT TREE RD
Second Line	:	SUITE 290
City	:	VACAVILLE
State	:	CA
Zip	:	95687-4100
Country	:	US
Telephone Number	:	707-624-8230
Fax Number	:	707-624-7998

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/02/2016

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