Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2216 | CA |
NPI | 1063619435 |
---|---|
Provider Name | Susan Cheryl Burnett-Hampson |
First Address | Merced, CA 95340-6805 |
Second Address | Los Banos, CA 93635-3453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190165 | RN# (01) | CA |
2216 | NP FURNISHER# (01) | CA |