Provider Demographics
NPI:1659551331
Name:FORD, SUSAN HUSKINS (RNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HUSKINS
Last Name:FORD
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:29936 VALLE OLVERA ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1641
Mailing Address - Country:US
Mailing Address - Phone:951-694-6102
Mailing Address - Fax:951-694-3804
Practice Address - Street 1:28910 RANCHO CALIFORNIA RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1869
Practice Address - Country:US
Practice Address - Phone:951-695-9183
Practice Address - Fax:951-676-6964
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN388453363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology