Provider Demographics
NPI:1629738612
Name:VAN DAAL, SUSAN (BSC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:VAN DAAL
Suffix:
Gender:F
Credentials:BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3617
Mailing Address - Country:US
Mailing Address - Phone:424-330-5356
Mailing Address - Fax:
Practice Address - Street 1:20800 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-3617
Practice Address - Country:US
Practice Address - Phone:424-330-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula