Provider Demographics
NPI:1659550226
Name:HONG CRANDALL, SUSAN S (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:HONG CRANDALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HONG-CRANDALL; HONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4151 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE111
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4753
Mailing Address - Country:US
Mailing Address - Phone:650-327-8888
Mailing Address - Fax:650-269-8624
Practice Address - Street 1:4151 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 111
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4753
Practice Address - Country:US
Practice Address - Phone:650-327-8888
Practice Address - Fax:650-269-8624
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN468870363LA2100X
CANPF 17502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF 17502OtherCA BRN
CANP17502OtherCA BRN