Provider Demographics
NPI:1245940543
Name:KIDMAN, SUSAN DENISE (LVN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENISE
Last Name:KIDMAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 APPLE ST STE B
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4455
Mailing Address - Country:US
Mailing Address - Phone:760-547-1280
Mailing Address - Fax:
Practice Address - Street 1:1905 APPLE ST STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4455
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN726141164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN726141OtherLICENSED VOCATIONAL NURSE