Provider Demographics
NPI:1770890279
Name:NOBLE, SUSAN ELVIRA (RN, PHN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELVIRA
Last Name:NOBLE
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:MS
Other - First Name:SANA
Other - Middle Name:
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:1380 HOWARD ST
Mailing Address - Street 2:2ND FLOOR, ROOM 211
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3671
Mailing Address - Fax:415-255-3496
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:2ND FLOOR, ROOM 211
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3671
Practice Address - Fax:415-255-3496
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494795163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse