Provider Demographics
NPI:1558922443
Name:VARTANIAN, SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:VARTANIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:RENEE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11618 E STROUD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-9218
Mailing Address - Country:US
Mailing Address - Phone:559-289-7478
Mailing Address - Fax:
Practice Address - Street 1:205 E RIVER PARK CIR STE 460
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1585
Practice Address - Country:US
Practice Address - Phone:559-261-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-22
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily