Provider Demographics
NPI:1467703561
Name:ALFORD, SUSAN NICOLE (CPNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NICOLE
Last Name:ALFORD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 PARK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4545
Mailing Address - Country:US
Mailing Address - Phone:510-523-3123
Mailing Address - Fax:510-864-1934
Practice Address - Street 1:1332 PARK ST STE 200
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4545
Practice Address - Country:US
Practice Address - Phone:510-523-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008913363LP0200X
AK1320363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMA3028594OtherDEA
AK1467703561Medicaid