Provider Demographics
NPI:1598908816
Name:GLABE, SUSAN KRISTINA (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KRISTINA
Last Name:GLABE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 MURIETA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-2832
Mailing Address - Country:US
Mailing Address - Phone:916-452-0333
Mailing Address - Fax:916-451-3769
Practice Address - Street 1:7 PARK CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8363
Practice Address - Country:US
Practice Address - Phone:916-569-4400
Practice Address - Fax:916-569-4401
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17081207R00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ04554Medicare UPIN