Provider Demographics
NPI:1295624609
Name:WANJIRU, SUSAN NJERI (LVN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NJERI
Last Name:WANJIRU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15034 SORREL RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7461
Mailing Address - Country:US
Mailing Address - Phone:713-992-7810
Mailing Address - Fax:
Practice Address - Street 1:15034 SORREL RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-7461
Practice Address - Country:US
Practice Address - Phone:713-992-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA749646164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse