Provider Demographics
NPI:1437197597
Name:JANSON, SUSAN L (DNSC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:JANSON
Suffix:
Gender:F
Credentials:DNSC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:JANSON-BJERHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNSC
Mailing Address - Street 1:1635 DIVISADERO STREET
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2961
Practice Address - Fax:415-353-2568
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA002430870Medicaid
CA002430870Medicaid
CA002430870Medicare PIN