Provider Demographics
NPI:1073646576
Name:WAHLBORG, SUZY RATTARO (RN344470)
Entity Type:Individual
Prefix:MRS
First Name:SUZY
Middle Name:RATTARO
Last Name:WAHLBORG
Suffix:
Gender:F
Credentials:RN344470
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 MUIR WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3652
Mailing Address - Country:US
Mailing Address - Phone:916-375-6380
Mailing Address - Fax:
Practice Address - Street 1:500 JEFFERSON BLVD STE B170
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95605-2393
Practice Address - Country:US
Practice Address - Phone:916-375-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344470163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health