Provider Demographics
NPI:1477218311
Name:FERRARO, SUE ANN (NP)
Entity Type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:FERRARO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 SANDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5387
Mailing Address - Country:US
Mailing Address - Phone:805-338-8162
Mailing Address - Fax:
Practice Address - Street 1:77 ROLLING OAKS DR STE 202
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1018
Practice Address - Country:US
Practice Address - Phone:805-387-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432373363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner