Provider Demographics
NPI:1952440588
Name:HASSE, SUSAN (RNC, NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HASSE
Suffix:
Gender:F
Credentials:RNC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 WHIPPLE AVE
Mailing Address - Street 2:#135
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2843
Mailing Address - Country:US
Mailing Address - Phone:650-366-5594
Mailing Address - Fax:650-366-6352
Practice Address - Street 1:2900 WHIPPLE AVE
Practice Address - Street 2:#135
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2843
Practice Address - Country:US
Practice Address - Phone:650-366-5594
Practice Address - Fax:650-366-6352
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261199363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP09402Medicare UPIN