Provider Demographics
NPI:1093016172
Name:CURTIN, SUSAN (RN,MSN,PNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:CURTIN
Suffix:
Gender:F
Credentials:RN,MSN,PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 CINNAMON TEAL
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2045 MEYER PL
Practice Address - Street 2:BLDG C
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2967
Practice Address - Country:US
Practice Address - Phone:949-515-6730
Practice Address - Fax:949-515-6727
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11268363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics