1770890279 NPI number — MS. SUSAN ELVIRA NOBLE RN, PHN

Table of content: MS. SUSAN ELVIRA NOBLE RN, PHN (NPI 1770890279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770890279 NPI number — MS. SUSAN ELVIRA NOBLE RN, PHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOBLE
Provider First Name:
SUSAN
Provider Middle Name:
ELVIRA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, PHN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOBLE
Provider Other First Name:
SANA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, PHN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770890279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1380 HOWARD ST
Provider Second Line Business Mailing Address:
2ND FLOOR, ROOM 211
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94103-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-255-3671
Provider Business Mailing Address Fax Number:
415-255-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1380 HOWARD ST
Provider Second Line Business Practice Location Address:
2ND FLOOR, ROOM 211
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94103-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-255-3671
Provider Business Practice Location Address Fax Number:
415-255-3496
Provider Enumeration Date:
09/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  494795 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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