Provider Demographics
NPI:1033358528
Name:MARDER, SUSAN (ANP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MARDER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 GEORGIA CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5114
Mailing Address - Country:US
Mailing Address - Phone:909-624-1239
Mailing Address - Fax:
Practice Address - Street 1:41120 WASHINGTON ST
Practice Address - Street 2:SUITE #101
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9215
Practice Address - Country:US
Practice Address - Phone:760-772-2823
Practice Address - Fax:760-772-2819
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306702363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health