Provider Demographics
NPI:1336147057
Name:CLAYDON, SUSAN DYER (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DYER
Last Name:CLAYDON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:150 CATHERINE LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5719
Mailing Address - Country:US
Mailing Address - Phone:530-271-2100
Mailing Address - Fax:530-271-2200
Practice Address - Street 1:150 CATHERINE LN
Practice Address - Street 2:SUITE B
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5719
Practice Address - Country:US
Practice Address - Phone:530-271-2100
Practice Address - Fax:530-271-2200
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA305917363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP79973Medicare UPIN