Provider Demographics
NPI:1346362316
Name:GRANT, SUZANNE J (NP)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:J
Last Name:GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:4317 ALDER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2323
Mailing Address - Country:US
Mailing Address - Phone:619-280-5587
Mailing Address - Fax:619-280-9039
Practice Address - Street 1:4020 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2106
Practice Address - Country:US
Practice Address - Phone:619-260-7022
Practice Address - Fax:619-260-7310
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA281041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner