Provider Demographics
NPI:1316090897
Name:MEALY, SUSAN JEAN (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JEAN
Last Name:MEALY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11530 OAK HILL DR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9568
Mailing Address - Country:US
Mailing Address - Phone:209-848-9133
Mailing Address - Fax:209-848-5338
Practice Address - Street 1:1420 W H ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3557
Practice Address - Country:US
Practice Address - Phone:209-848-4180
Practice Address - Fax:209-848-5338
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP4670363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health