Provider Demographics
NPI:1073564845
Name:TRANIELLO HINES, SUSAN (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TRANIELLO HINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E FOOTHILL BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2549
Mailing Address - Country:US
Mailing Address - Phone:626-471-6500
Mailing Address - Fax:626-471-3575
Practice Address - Street 1:301 E FOOTHILL BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2549
Practice Address - Country:US
Practice Address - Phone:626-471-6500
Practice Address - Fax:626-471-3575
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 482235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABB662ZOtherMEDICARE PROVIDER
CARN 482235Medicaid
CA14801OtherNURSE PRACTIONER
CABB662YOtherMEDICARE PROVIDER