Provider Demographics
NPI:1689740722
Name:MYKITA, SUSAN HILLARY (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HILLARY
Last Name:MYKITA
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:HILLARY
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:4700 COLLEGE OAK DR
Practice Address - Street 2:AMERICAN RIVER COLLEGE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-4217
Practice Address - Country:US
Practice Address - Phone:916-484-8383
Practice Address - Fax:916-484-8759
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN293133163WC1400X
CANP7781363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health