Provider Demographics
NPI:1407517543
Name:ROBERTS, SUSAN JANE (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33385 BARCELONA DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-4011
Mailing Address - Country:US
Mailing Address - Phone:310-874-4299
Mailing Address - Fax:
Practice Address - Street 1:7885 ANNANDALE AVE OFC
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-1419
Practice Address - Country:US
Practice Address - Phone:760-329-8932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-30
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA703381163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice