Provider Demographics
NPI:1962601948
Name:CRISP, SUSAN ASHLEY (NP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASHLEY
Last Name:CRISP
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ASHLEY
Other - Last Name:SINIARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14355 MIRANDA WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2032
Mailing Address - Country:US
Mailing Address - Phone:888-731-8994
Mailing Address - Fax:861-833-7751
Practice Address - Street 1:195 PAGE MILL RD STE 103
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2073
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:861-833-7751
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135490363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962601948OtherNPI
GA739494497BMedicaid
GA739494497CMedicaid
GA202I424462Medicare PIN