Provider Demographics
NPI:1770634255
Name:MORENZ, SUSAN EILEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:EILEEN
Last Name:MORENZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 ORANGE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-1623
Mailing Address - Country:US
Mailing Address - Phone:714-538-4036
Mailing Address - Fax:714-538-5226
Practice Address - Street 1:10735 ORANGE PARK BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-1623
Practice Address - Country:US
Practice Address - Phone:714-538-4036
Practice Address - Fax:714-538-5226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA775367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANA775OtherLICENSE
NA35787OtherNATIONAL LICENSE