Provider Demographics
NPI:1003122466
Name:GREENBERG, SUSAN (GNP, RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:GNP, RN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BLACKMUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 PETALUMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-326-1500
Mailing Address - Fax:
Practice Address - Street 1:500 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4216
Practice Address - Country:US
Practice Address - Phone:707-326-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA328095163WG0600X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH1000XNursing Service ProvidersRegistered NurseHospice