Provider Demographics
NPI:1861519852
Name:PERON, SUSAN LOUISE (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LOUISE
Last Name:PERON
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 1:7870 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9787
Mailing Address - Country:US
Mailing Address - Phone:559-834-5008
Mailing Address - Fax:559-834-6653
Practice Address - Street 1:1140 T ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1413
Practice Address - Country:US
Practice Address - Phone:559-459-6416
Practice Address - Fax:559-459-2494
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily