Provider Demographics
NPI:1366609018
Name:BATES, SUSAN GLENNETTE (RN, FIRST ASSIST)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:GLENNETTE
Last Name:BATES
Suffix:
Gender:F
Credentials:RN, FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26004 WHISPERING OAK LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9671
Mailing Address - Country:US
Mailing Address - Phone:559-325-6776
Mailing Address - Fax:
Practice Address - Street 1:26004 WHISPERING OAK LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-9671
Practice Address - Country:US
Practice Address - Phone:559-325-6776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358165163W00000X, 163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant