Provider Demographics
NPI:1184817322
Name:JED, SUZANNE L (MSN, APRN-BC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:JED
Suffix:
Gender:F
Credentials:MSN, APRN-BC
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:HUFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN-BC
Mailing Address - Street 1:1640 MARENGO ST
Mailing Address - Street 2:HRA 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1036
Mailing Address - Country:US
Mailing Address - Phone:323-226-2200
Mailing Address - Fax:323-226-2505
Practice Address - Street 1:1640 MARENGO ST
Practice Address - Street 2:HRA 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1036
Practice Address - Country:US
Practice Address - Phone:323-226-2200
Practice Address - Fax:323-226-2505
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily