Provider Demographics
NPI:1538627831
Name:KIMANI, SUSAN WANJIKU (RN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:WANJIKU
Last Name:KIMANI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 GOLD WAY
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-1545
Mailing Address - Country:US
Mailing Address - Phone:707-731-4331
Mailing Address - Fax:
Practice Address - Street 1:2200 RANGE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-9472
Practice Address - Country:US
Practice Address - Phone:707-200-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95175484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse