Provider Demographics
NPI:1194703843
Name:MCKEEFREY, SUSAN PATRICIA (MN, ARNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PATRICIA
Last Name:MCKEEFREY
Suffix:
Gender:F
Credentials:MN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3600
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:650 N FULTON ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3404
Practice Address - Country:US
Practice Address - Phone:559-488-4900
Practice Address - Fax:559-488-4999
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP-30001938363LP2300X
CANP21794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care