Provider Demographics
NPI:1730304676
Name:SUARES, SUSAN E (MSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SUARES
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:EILEEN
Other - Last Name:SUARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1600 CREEKSIDE DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3445
Mailing Address - Country:US
Mailing Address - Phone:916-932-4163
Mailing Address - Fax:916-932-4167
Practice Address - Street 1:1600 CREEKSIDE DR STE 1200
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3445
Practice Address - Country:US
Practice Address - Phone:916-932-4163
Practice Address - Fax:916-932-4167
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 12249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00442854OtherRAILROAD MEDICARE
CAP00442854OtherRAILROAD