Provider Demographics
NPI:1851476642
Name:MCCLARTY, SUSANNA (RN NURSE PRACTITIONE)
Entity Type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:
Last Name:MCCLARTY
Suffix:
Gender:F
Credentials:RN NURSE PRACTITIONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3391
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2391
Mailing Address - Country:US
Mailing Address - Phone:562-237-7021
Mailing Address - Fax:
Practice Address - Street 1:601 W 19TH ST
Practice Address - Street 2:PLANNED PARENTHOOD OF ORANGE AND SAN BERNADINO COUNTIES
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-548-8830
Practice Address - Fax:949-548-9051
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN246446163W00000X
CA7269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse