Provider Demographics
NPI:1891767026
Name:STRONG, SUSAN A D (FNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A D
Last Name:STRONG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34835 MAPLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6841
Mailing Address - Country:US
Mailing Address - Phone:909-793-6399
Mailing Address - Fax:909-307-1027
Practice Address - Street 1:351 N MOUNTAIN VIEW AVE RM 104
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0003
Practice Address - Country:US
Practice Address - Phone:909-387-6797
Practice Address - Fax:909-387-6377
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA383852OtherRN LICENSE NUMBER
CAZZZ18911ZMedicaid
CA8688OtherNP FURNISHING
CAMS0735918OtherDEA
CAP15429Medicare UPIN