Provider Demographics
NPI:1225609035
Name:KUDER, SUSAN KAY II
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KAY
Last Name:KUDER
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11037 ERICKSON WAY SPC 1811037
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2934
Mailing Address - Country:US
Mailing Address - Phone:856-431-4629
Mailing Address - Fax:
Practice Address - Street 1:11037 ERICKSON WAY SPC 1811037
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2934
Practice Address - Country:US
Practice Address - Phone:856-431-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3417740
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC3417740Medicaid