Provider Demographics
NPI:1467077610
Name:CALCUTT, SUZANNE RENE' (MSN, FNP-BC, PHN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:RENE'
Last Name:CALCUTT
Suffix:
Gender:F
Credentials:MSN, FNP-BC, PHN
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENE'
Other - Last Name:SCHUENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4263 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1208
Mailing Address - Country:US
Mailing Address - Phone:619-249-0273
Mailing Address - Fax:
Practice Address - Street 1:3327 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4223
Practice Address - Country:US
Practice Address - Phone:619-225-9691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-13
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014219363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557640OtherCALIFORNIA PUBLIC HEALTH NURSE
CA95014219OtherCALIFORNIA BRN - FAMILY NURSE PRACTITIONER
CANPF95014219OtherCALIFORNIA BRN - FNP FURNISHING NUMBER
CA729393OtherCALIFORNIA BOARD OF REGISTERED NURSING - RN LICENSE