Provider Demographics
NPI:1568565489
Name:STENHOUSE, SUELLEN ROSE (PA)
Entity Type:Individual
Prefix:
First Name:SUELLEN
Middle Name:ROSE
Last Name:STENHOUSE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUELLEN
Other - Middle Name:ROSE
Other - Last Name:STENHOUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1231 PLUMAS ST
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3410
Mailing Address - Country:US
Mailing Address - Phone:530-751-8454
Mailing Address - Fax:530-751-8456
Practice Address - Street 1:1231 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3410
Practice Address - Country:US
Practice Address - Phone:530-751-8454
Practice Address - Fax:530-751-8456
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12264363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12264OtherLICENSE