Provider Demographics
NPI:1366067449
Name:MISCHKE, SUSANN (NP)
Entity type:Individual
Prefix:
First Name:SUSANN
Middle Name:
Last Name:MISCHKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSANN
Other - Middle Name:
Other - Last Name:MISCHKE-SLIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-5170
Mailing Address - Country:US
Mailing Address - Phone:707-547-7999
Mailing Address - Fax:
Practice Address - Street 1:1165 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4801
Practice Address - Country:US
Practice Address - Phone:707-525-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-14
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014135363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care