MEDICARE: MRS. SUSAN M BAARSCH RN, PHN

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	163W00000X	Registered Nurse	763811	CA

General Provider Information

NPI Number	:	1942614508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN M BAARSCH RN, PHN

Provider Business Mailing Address
First Line	:	6864 BEAR RIVER ROW UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6864 BEAR RIVER ROW UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-2720
Country	:	US
Telephone Number	:	619-339-7451
Fax Number	:

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

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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