Provider Demographics
NPI:1700951621
Name:KILLING, SUSANNE ISABEL (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:ISABEL
Last Name:KILLING
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 CHAUCER ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2032
Mailing Address - Country:US
Mailing Address - Phone:415-558-5900
Mailing Address - Fax:415-558-5959
Practice Address - Street 1:90 VAN NESS AVENUE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-558-5900
Practice Address - Fax:415-558-5959
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 557976163W00000X
CANPF12780363LA2200X
CACNS 1531364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP71896Medicare UPIN