Provider Demographics
NPI:1659439602
Name:ROSTEN, SUSAN J (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:ROSTEN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1020 NUT TREE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4100
Mailing Address - Country:US
Mailing Address - Phone:707-624-8230
Mailing Address - Fax:707-624-7998
Practice Address - Street 1:1020 NUT TREE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4100
Practice Address - Country:US
Practice Address - Phone:707-624-8230
Practice Address - Fax:707-624-7998
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA10076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27591Medicare UPIN