Provider Demographics
NPI:1194019448
Name:HARADA, SUSAN S (RN, MN, NP, COHN-S)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:HARADA
Suffix:
Gender:F
Credentials:RN, MN, NP, COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 BEDFORD PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5329
Mailing Address - Country:US
Mailing Address - Phone:805-497-2586
Mailing Address - Fax:
Practice Address - Street 1:405 BEDFORD PL
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5329
Practice Address - Country:US
Practice Address - Phone:805-497-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 454758363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health