Provider Demographics
NPI:1356338354
Name:MOFFATT, SUSAN L (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N DOS CAMINOS AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1660
Mailing Address - Country:US
Mailing Address - Phone:805-653-5070
Mailing Address - Fax:805-653-8099
Practice Address - Street 1:231 N DOS CAMINOS AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1660
Practice Address - Country:US
Practice Address - Phone:805-653-5070
Practice Address - Fax:805-653-8099
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6257363LF0000X
CA333036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333036OtherRN NP #
P39557Medicare UPIN
WNP6257AMedicare ID - Type Unspecified